INTRODUCTION:Immediately prior to the COVID-19 pandemic, our public hospital implemented an enhanced recovery after surgery (ERAS) protocol. The purpose of this study was to evaluate ERAS outcomes for hysterectomy patients at our public hospital, given concerns about barriers to care in our underserved population.METHODS:A retrospective analysis was performed comparing outcomes (percent of outpatient cases, length of stay, perioperative opioids, percent of emergency department [ED] return) for hysterectomy patients for pre- and post-intervention periods (January to June in 2019 and 2021). Outcomes were compared using the Fisher exact test or t-test.RESULTS:A total of 192 preintervention and 120 post-intervention hysterectomy cases were analyzed. The majority of patients were Hispanic/Latinx in both groups (82% vs. 76%; P=.25). There was no significant change in the percentage of minimally-invasive procedures (71% vs 72%; P=1.0). The percentage of outpatient hysterectomies increased from 0% to 53% (P<.0001), and the mean length of stay (LOS) decreased from 1.6 days to 0.9 days (P<.0001). Peri-operative mean morphine milligram equivalents (MME) decreased from 78 to 54 (P≤.02). Mean post anesthesia care unit stay increased from 186 to 229 minutes (P<.01). There was no significant increase in returns to the ED <30 days (10% vs 13%; P=.36) or mean number of opioid pills prescribed (13 vs 13; P=.21).CONCLUSION:ERAS implementation for hysterectomy patients at a public hospital decreased LOS and peri-operative opioids without significantly increasing ED returns. The COVID-19 pandemic likely helped to expedite the adoption of outpatient management, which was feasible and safe in our underserved patient population.
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