The aim of this study is to evaluate compliance and outcomes with implementation of an enhanced recovery surgical protocol in older women undergoing pelvic reconstructive surgery. This is a retrospective cohort study of women undergoing pelvic reconstructive surgery after implementation of the pathway over a 12-month period. Overall compliance was defined as a categorial variable requiring adherence to all of the selected bundle components in patients <65 years old compared to those ≥65. Intraoperative and 30-day postoperative complications were also compared and were reviewed by organ system, these were categorized using the Clavien-Dindo Classification system. There was no significant difference in overall compliance in patients <65 compared to ≥65. Factors that increased compliance in patients ≥65 include laparotomy, hysterectomy, hyperlipidaemia, time after implementation of the protocol and primary surgeon. There was an increase in compliance from 19% to 77% over the 12-month study period. Intra and postoperative complications were similar between the two groups. Enhanced recovery in older patients undergoing pelvic reconstructive surgery is feasible with similar rates of compliance and complications compared to younger patients. Compliance with the protocol increases as time after implementation of the protocol increases in all patients.
Purpose of review
Enhanced recovery after surgery (ERAS) programs aim to expedite functional recovery and improve surgical outcomes without increasing complications or cost. First championed by colorectal surgeons, ERAS protocols are now widely utilized among surgical subspecialties. The present review focuses on use of ERAS pathways in minimally invasive gynecologic surgery (MIGS) and risk factors for suboptimal outcomes in this population.
Recent findings
Studies across multiple fields has shown benefit to adoption of ERAS protocols. However, lack of protocol standardization among institutions, implementation of interventions as a bundle, varied compliance, and lack of study randomization collectively obscure generalizability of findings from such studies. Emerging data in fact suggest benefits may not translate equally across all populations, cautioning against indiscriminate application of protocols to all surgeries or patients. Thus applicability of ERAS protocols to the MIGS population merits close examination.
Summary
ERAS protocols improve postoperative outcomes, satisfaction, and cost of care for most patients undergoing gynecologic surgery. However, modifications to typical ERAS protocols may be beneficial to certain subsets of patients including patients with chronic pelvic pain, opiate dependence, or psychiatric disorders. Identification of risk factors for admission or increased hospital stay may help guide protocol modifications for at-risk groups within the MIGS population.
Study Objective
The value of simulation to develop specific skills in a controlled environment is well established among surgical specialties. It is unknown whether such skills transfer to clinical settings. The aims of this review are: 1. to determine if simulation training translates to improved surgical performance by Obstetric/Gynecology (OBGYN) trainees in operative settings; 2. to determine impact of simulation on clinical outcomes.
Design
MEDLINE, EMBASE, Cochrane, ERIC, and Psychinfo databases were searched through October 2019 to identify studies evaluating the use of simulation among OBGYN trainees. Studies were included if they assessed trainees’ skills in real surgical cases by objective measure after implementation of simulation training. Studies assessing only simulator performance were excluded.
Setting
N/A
Patients or Participants
OBGYN trainees.
Interventions
Simulation training.
Measurements and Main Results
457 abstracts were screened and 16 included in the final analysis. Most studies used an Objective Structured Assessment of Technical Skills (OSAT) or modified version during laparoscopic salpingectomy or tubal ligation. Ten studies found performance improvement after simulation training. Fewer studies assessed impact on clinical outcomes. Of these, half noted a decrease in operative time with simulation. Length of stay was found to significantly decrease; however, no significant difference in other clinical outcomes was noted following simulation. Most trainees reported satisfaction and self-perceived increase in surgical skills following simulation training.
Conclusion
This is the first systematic review to evaluate the translation of gynecologic surgical skills to the operating room following simulation training. Skills developed through simulation appear to be transferable to the operating room. More numerous studies are needed to better assess effects on clinical outcomes and whether findings hold true with increasing case complexity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.