The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy

Marx, Charlotte; Rasmussen, Torben Valdbjørn; Jakobsen, Dorthe Hjort; Ottosen, Christian; Lundvall, Lene; Ottesen, Bent; Callesen, Torben; Kehlet, Henrik

doi:10.1080/00016340500408325

Cited by 99 publications

(75 citation statements)

References 16 publications

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“…Our study group consisted mostly of a group of low-risk endometrial cancers (FIGO stage 1) or early ovarian cancer, for which our national guidelines recommend this less-extensive surgery. We cannot therefore say anything directly about the outcome after more extensive surgery, but there are also some data from other studies suggesting the same benefit in this group [7,10]. In addition, patients who have undergone more extensive surgery would probably benefit equally or even more from stress reduction.…”

Section: Discussionmentioning

confidence: 89%

“…The reasons for not including patients with malignant disease in these early studies have not been stated. Some of the more recent studies have used fast-track or ERAS protocols in patients with malignant disease who have undergone various types of gynecological surgeries [7,8,9,10], all with the same conclusion of achieving shorter LOS and enhancing recovery. These studies included prospectively collected data in ERAS-treated patients compared with historical controls, or were performed retrospectively.…”

Section: Introductionmentioning

confidence: 99%

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Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease

Wijk¹,

Franzén²,

Ljungqvist

et al. 2016

Gynecol Obstet Invest

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Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days). Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), reoperations (0 vs. 2%), or readmissions (2 vs. 1%). Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease

Wijk¹,

Franzén²,

Ljungqvist

et al. 2016

Gynecol Obstet Invest

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“…This study has demonstrated that with experience, 1 in 3 patients undergoing a laparotomy for gynaecological surgery can be discharged on day 2 post surgery, without an increased morbidity or readmission rate [8,9].…”

Section: Discussionmentioning

confidence: 99%

Early discharge after major gynaecological surgery: advantages of fast track surgery

Carter

Philp²,

Arora³

2011

OJOG

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Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54 (22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the readmission rate or morbidity.

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“…(Marx, 2006& Jakobsen, 2010 The first of these, published in Acta Obstetricia et Gynecologica in 2006, was a case control study involving a total of 141 women. One group (comprising 72 women) received conventional care and were analysed retrospectively whilst the second group (69 women) received multimodal rehabilitation and were studied prospectively.…”

Section: Discussionmentioning

confidence: 99%

“…The next study examined at was 'The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy' by Marx et al (Marx, 2006) This was a case control study looking at surgery for ovarian malignancy (undertaken according to guidelines from the International Federation of Gynecology and Obstetrics). A total of 141 women were included: 72 patients receiving conventional perioperative care were compared with 69 patients receiving multimodal, fast-track rehabilitation.…”

Section: Enhanced Recovery After Surgery With Reference To Hysterectomymentioning

confidence: 99%

Innovations in the Care of Postoperative Hysterectomy Patients

Saleh¹,

Majumdar²

2012

Hysterectomy

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The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy

Abstract: The concept of fast-track multimodal rehabilitation appears to be beneficial in patients operated for ovarian malignancy, as hospital stay and medical morbidity are reduced.

Cited by 99 publications

References 16 publications

Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease

Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease

Early discharge after major gynaecological surgery: advantages of fast track surgery

Innovations in the Care of Postoperative Hysterectomy Patients

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