RT Journal Article
SR Electronic
T1 Enhanced Recovery After Surgery protocol implementation was associated with decreased narcotic use, lower maximum pain scores, and expedited return of baseline functions among medically complex gynecologic oncology patients
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP ijgc-2018-000131
DO 10.1136/ijgc-2018-000131
A1 Amanda Rae Schwartz
A1 Stephanie Lim
A1 Gloria Broadwater
A1 Lauren Cobb
A1 Fidel Valea
A1 Julie Marosky Thacker
A1 Ashraf Habib
A1 Laura Havrilesky
YR 2019
UL http://ijgc.bmj.com/content/early/2019/05/02/ijgc-2018-000131.abstract
AB Objective Enhanced Recovery After Surgery (ERAS) protocols are designed to mitigate the physiologic stress response created by surgery, to decrease the time to resumption of daily activities, and to improve overall recovery. This study aims to investigate postoperative recovery outcomes following gynecologic surgery before and after implementation of an ERAS protocol.Methods A retrospective chart review was performed of patients undergoing elective laparotomy at a major academic center following implementation of an ERAS protocol (11/4/2014–7/27/2016) with comparison to a historical cohort (6/23/2013–9/30/2014). The primary outcome was length of hospital stay. Secondary outcomes included surgical variables, time to recovery of baseline function, opioid usage, pain scores, and complication rates. Statistical analyses were performed using Wilcoxon rank sum, Fisher’s exact, and chi squared tests.Results One hundred and thirty-three women on the ERAS protocol who underwent elective laparotomy were compared with 121 historical controls. There was no difference in length of stay between cohorts (median 4 days; P = 0.71). ERAS participants had lower intraoperative (45 vs 75 oral morphine equivalents; P < 0.0001) and postoperative (45 vs 154 oral morphine equivalents; P < 0.0001) opioid use. ERAS patients reported lower maximum pain scores in the post-anesthesia care unit (three vs six; P < 0.0001) and on postoperative day 1 (four vs six; P = 0.002). There was no statistically significant difference in complication or readmission rates.Conclusions ERAS protocol implementation was associated with decreased intraoperative and postoperative opioid use and improved pain scores without significant changes in length of stay or complication rates.