Enhanced Recovery After Urogynecologic Surgery: A Survey of Patient Experience

Abstract

ObjectivesThe aim of this study was to identify which aspects/components of the enhanced recovery program (ERP) were associated with a positive patient surgical experience for patients undergoing urogynecologic surgery.MethodsA total of 198 patients who underwent pelvic reconstructive surgery requiring hospital admission were invited to complete questionnaires modeled after the validated Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey patient experience survey. Patients were asked about 3 phases of ERP interventions: (1) before surgery (patient education, carbohydrate loading), (2) during the hospital stay (pain control, nausea, early ambulation), and (3) after discharge (return of bladder and bowel function).ResultsOne hundred patients completed the survey (51% response rate). Greater than 90% of patients rated their overall surgical experience favorably (≥8 on 1–10 scale) regardless of age (P = 0.98), race (P = 0.26), education level (P = 0.12), perception of overall health (P = 0.17), or number of prior surgical procedures (P = 0.86). Ninety-two percent of patients reported that preoperative teaching about surgery was “very helpful,” and specifically 90% reported that the ERP educational handbook was useful. Patients who reported a poor perception of their overall mental health were more likely to rate their surgical experience less favorably (<8 on 1–10 scale; P = 0.01), as were patients who left the hospital with a Foley catheter (P = 0.03).ConclusionsGreater than 90% of women surveyed who rated undergoing inpatient pelvic reconstructive surgery positively perceived their surgical experience within the ERP. The majority of patients who had a positive perception of the perioperative experience found the preoperative patient education useful.

Effects of Same-Day Discharge on 30-Day Readmission Rates in Women Aged 65 Years and Older Undergoing Minimally Invasive Pelvic Organ Prolapse Surgery

“…As programs such as the Hospital Readmissions Reduction Program expand to POP surgery, 30day hospital readmission will grow in importance in a pay-for-performance health care system because it serves as a surrogate marker for quality and safety. Enhanced recovery after surgery (ERAS) protocols decrease multiple-day hospital admissions, postoperative pain, and adverse events and have been successfully applied in urogynecology, [13][14][15][16] thus making same-day discharge a viable option for women undergoing POP surgery. In both single-site and large multisite studies, same-day discharge has been shown to be a safe alternative to next-day discharge (with sim-ilar readmission and ED rates) with high patient satisfaction.…”

“…In both single-site and large multisite studies, same-day discharge has been shown to be a safe alternative to next-day discharge (with sim-ilar readmission and ED rates) with high patient satisfaction. 2,4,7,15 Currently, the evidence that same-day discharge is safe in older women undergoing POP surgery is limited, and without clear safety data, implementation may be limited. Surgeons may believe that this older group is at higher risk of complications 17 and readmission, and as a result, some surgeons may be reluctant to implement same-day discharge protocols for this cohort of patients.…”

“…Although the literature reports high patient satisfaction with same-day discharge, 2,4,15 there is a paucity of safety data comparing same-day discharge with next-day discharge in older patients in terms of 30-day readmission rates after POP surgery. In our study, we evaluated patients aged 65 years and older, a population at increasing risk of POP and POP surgery in their lifetime.…”

“…In both single-site and large multisite studies, same-day discharge has been shown to be a safe alternative to next-day discharge (with similar readmission and ED rates) with high patient satisfaction. 2,4,7,15…”