Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease

Abstract

Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications. Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days). Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), reoperations (0 vs. 2%), or readmissions (2 vs. 1%). Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

Effect of intrathecal morphine and epidural analgesia on postoperative recovery after abdominal surgery for gynecologic malignancy: an open-label randomised trial

“…A reduction of hospital stay with 1 day has clinical relevance for both the patient and the healthcare system. A similar short LOS has recently been reported from other ERAS programmes for gynaecological cancer 27–29. Wijk et al 27 used an analgesic regimen based on oral paracetamol and diclofenac and over 90% of the patients did not need systemic opioids from the day after surgery.…”

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

“…2,4,11 Specifically, ERAS pathways in gynecologic surgery have reportedly been successful 4,14,15 at addressing the issues thereof, but the results have been limited by relatively small patient populations and the inclusion of study participants with benign disease and data that have primarily reflected observations from academic medical centers. 12,16 In the current investigation, we report our experience in implementing an ERAS protocol with a gynecologic oncology population that was treated in the community hospital setting.…”

“…4,5 Initially, ERAS protocols were primarily instituted in the field of colorectal surgery, 6,7 emphasizing the beneficial use of preoperative medication, limited use of bowel preps, multimodal analgesia, intraoperative fluid restriction, prompt enteral nutrition, and early patient ambulation. 2,4,8Y10 Enhanced recovery after surgery regimens have been employed in gynecologic surgery 4,11 and in Europe, 1,12,13 but scarcely in the community hospital setting.…”

Enhanced Recovery after Surgery in Gynecology: A Review of the Literature

“…Malignancy and duration of surgery were predictors of longer LOS in 2 studies [28,30]. In 5 studies increasing age correlated to increases in LOS [19,20,28,30,31].…”

“…More patients were discharged within 2 days after implementing the ERAS protocol (73% vs 56%). In a later study, Wijk et al [20] compared open hysterectomy for benign indications with malignant indications. No significant differences were found in LOS (2 days for both groups) or proportion discharged at target LOS of 2 days (62 vs 69%).…”