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Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery
  1. Maria D Iniesta1,
  2. Javier Lasala2,
  3. Gabriel Mena2,
  4. Andrea Rodriguez-Restrepo3,
  5. Gloria Salvo1,
  6. Brandelyn Pitcher4,
  7. Lakisha D Washington1,
  8. Melinda Harris1,
  9. Larissa A Meyer1 and
  10. Pedro T Ramirez1
  1. 1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Department of Anesthesiology and Perioperative Medicine, Northern Arizona University-Tucson Campus, Tucson, Arizona, USA
  4. 4Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Pedro T Ramirez, Gynecologic Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA; peramire{at}mdanderson.org

Abstract

Objective The aim of this study was to evaluate if varying levels of compliance with an enhanced recovery after surgery (ERAS) protocol impacted post-operative outcomes (length of stay, complications, readmissions, and re-operations) in gynecologic surgery at a tertiary center.

Methods We included 584 patients who had open gynecologic surgery between November 1, 2014 and December 31, 2016. Patients were categorized into subgroups according to their date of surgery from the time of the ERAS protocol implementation. Patients were categorized by their per cent compliance into two groups:<80% versus ≥80%. We analyzed compliance with the elements of the protocol over time and its relation with post-operative outcomes, length of stay, post-operative complications, readmission, and re-operations rates. We modeled the probability of having a post-operative complication within 30 days of surgery as a function of overall compliance.

Results Overall compliance was 72.3%. Patients with compliance ≥80% had significantly less complications (P<0.001) and shorter length of stay (P<0.001). Readmission and re-operation rates were not impacted by compliance (P=0.182, P=0.078, respectively). Avoidance of salt water overload, early mobilization, early oral nutrition, and early removal of Foley catheter were significantly associated with less post-operative complications within 30 days.

Conclusions Compliance with an ERAS pathway exceeding 80% was associated with lower complication rates and shorter length of stay without impacting on re-operations or readmissions.

  • ERAS
  • compliance
  • gynecologic surgery
  • postoperative outcomes
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Footnotes

  • Contributors All authors have directly participated in the planning, execution, or analysis of our study and have read and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board at the University of Texas MD Anderson Cancer Center approved the protocol (PA16-0939).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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