RT Journal Article
SR Electronic
T1 Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP 1417
OP 1424
DO 10.1136/ijgc-2019-000622
VO 29
IS 9
A1 Maria D Iniesta
A1 Javier Lasala
A1 Gabriel Mena
A1 Andrea Rodriguez-Restrepo
A1 Gloria Salvo
A1 Brandelyn Pitcher
A1 Lakisha D Washington
A1 Melinda Harris
A1 Larissa A Meyer
A1 Pedro T Ramirez
YR 2019
UL http://ijgc.bmj.com/content/29/9/1417.abstract
AB 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.