Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta‐analysis

Groot, Jeanny J. A. de; Ament, Stephanie M C; Maessen, J.; Dejong, Cornelis H. C.; Kleijnen, Jos; Slangen, Brigitte

doi:10.1111/aogs.12831

Cited by 87 publications

(70 citation statements)

References 68 publications

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“…An important consistency among these trials, and shared with this retrospective cohort, is the mixed malignant and benign patient populations. A 2015 meta-analysis of the ERAS program in gynecology performed a subgroup analysis of length of stay according to patient pathology, which concluded that 'introduction of an ERAS pathway did not significantly affect length of stay in the study with a mixed (benign or malignant) patient group' 27. Another possible contributing factor is the lack of clearly defined minimal discharge criteria.…”

Section: Discussionmentioning

confidence: 99%

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Schwartz

Lim

Broadwater

et al. 2019

Int J Gynecol Cancer

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ObjectiveEnhanced 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.MethodsA 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.ResultsOne 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.ConclusionsERAS 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.

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Section: Discussionmentioning

confidence: 99%

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Schwartz

Lim

Broadwater

et al. 2019

Int J Gynecol Cancer

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“…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.…”

mentioning

confidence: 99%

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

Mendivil

Busch²,

Richards³

et al. 2018

Int J Gynecol Cancer

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“…We found a possible subsequent mobilization effect after patients' experienced harmony or disharmony between patients' interpretation of healthcare professional attitude and own experienced health state, but our data is not exhaustive in this regard. Early mobilization is regarded important (Bakhru et al, 2015) and is a common part of early recovery pathways after surgery (de Groot et al, 2016;Day et al, 2015). What affects early postoperative mobilization is multifactorial, which need further investigation, and our input might go some way to explain why tests of early mobilization programs give mixed results (Castelino et al, 2016).…”

Section: Discussionmentioning

confidence: 98%

How Communication Disharmonies between Patients and Nurses Can Affect Patients—A Qualitative Study of Illness Experienced from the Patients View

Thygesen¹,

Pedersen²

2017

PSYCH

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Patient-provider interaction is important for cancer patients' wellbeing and further coping and it might be beneficial to further investigate this in the fast track trajectories. Cancer patients experience themselves as liminal and we aimed to investigate how patients experience healthcare professionals' attitude with regard to the patients' own illness experience. Diaries, observation notes, and an elicitation technique supported in the semi-structured interview situations with eight female patients few days after discharge after gynecological cancer surgery were used. Data were transcribed verbatim and analyzed using a Ricoeur inspired technique, which started open-minded. Situations with harmony between patients' experience of their health state and nurses' signals in this regard were more peaceful and energizing for the patients than situations with disharmony, which gave limbo experiences and drained of energy. The Broaden and Build theory and the Sense of Coherence theory might support our findings. True presence of the nurse is important in order to meet the patient where she is and communicate from there. More evidence based suggestions for future clinical foci are given. Female cancer patients can be vulnerable to healthcare professionals' small signals regarding the patients' state of health, and harmony or disharmony between these signals and patients' own experiences means a difference to their psychological wellbeing. It might also mean a difference to early mobilization.

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Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta‐analysis

Abstract: The available evidence based on a broad range of non-randomized studies at high risk of bias suggests that enhanced recovery pathways may reduce length of postoperative hospital stay in abdominal gynecologic surgery.

Cited by 87 publications

References 68 publications

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service

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

How Communication Disharmonies between Patients and Nurses Can Affect Patients—A Qualitative Study of Illness Experienced from the Patients View

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