Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery

Trowbridge, Elisa R.; Evans, Sarah; Sarosiek, Bethany M.; Modesitt, Susan C.; Redick, Dana L.; Tiouririne, Mohamed; Thiele, Robert H.; Hedrick, Traci L.; Hullfish, Kathie L.

doi:10.1007/s00192-018-3794-0

Cited by 33 publications

(75 citation statements)

References 18 publications

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“…One-on-one teaching as well as group sessions in structured "gynecology school" on the ERAS pathway (with audiovisual materials and question-and-answer sessions) have been described. In addition, in a recent study, with the addition of a formal ERAS teaching session and a newly hired "enhanced recovery" nurse, the ERAS protocol was associated with cost savings of approximately 10% [12,13].…”

Section: Preoperative Education and Counselingmentioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.

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Section: Preoperative Education and Counselingmentioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…TLOS represents total LOS within 30 days of surgery, including readmission days. Twenty-four studies 17-23, 25-36, 38-42 reported PLOS, five studies 20,23,24,34,37 reported TLOS, and eight studies 24,26,28,29,32,36,40,43 reported TLOS. Compared with the control group, the PLOS of ERAS group was significantly shortened (SMD=-0.681, 95% CI: -0.844-0.517, P<0.01), TLOS was significantly shortened(SMD=-0.312, 95% CI: -0.551-0.073, P=0.011), and tLOS increased significantly(OR=4.899, 95% CI: 3.825-6.276, P<0.01).…”

Section: Meta-analysismentioning

confidence: 99%

“…But existing systems review studies do not focus on tLOS. As medical developments in recent years have focused on shortening the length of hospital stay, in some medical institutions, even before ERAS pathways was developed, some patients had a very short hospital stay for minimally invasive, pelvic floor surgery and minor open surgery, and could even be discharged on the same day of surgery 36,40,43 . Therefore, ERAS pathways studies of these medical institutions cannot find the advantages of ERAS pathways if the evaluation of their results focuses on the length of hospitalization.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) in Gynaecology: a meta-analysis

Song

Wang

Zhang

et al. 2020

Preprint

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Background Enhanced recovery after surgery (ERAS), which originated in colorectal surgery, has been implemented in different types of surgery, but its effectiveness in gynaecologic surgery remains to be determined. Objectives A meta-analysis was conducted on the existing studies to compare the effects of ERAS pathways and routine management on the outcomes of gynaecological surgeries. Search Strategy The main database was retrieved from inception to 24 July 2020 using the term 'enhanced recovery after surgery' and its changes, as well as search restrictions for related study designs. Selection Criteria Studies whose number of ERAS pathways projects implemented by the ERAS group but not by the conventional surgery group was no less than four were included. Outcomes included length of hospital stay, complications, and so on. Data Collection and Analysis According to the accurate data extraction table, the fixed or random effects model was used to summarize. Main Results The length of hospital stay (LOS) situation of the ERAS group was significantly shorter than that of the control group, including the shortening of primary LOS (SMD=-0.681, 95% CI:-0.844-0.517, P<0.01) and total LOS (SMD=-0.312, 95% CI:-0.551-0.073, P=0.011), as well as the increase of the number of people reaching the target LOS (OR=4.899, 95% CI: 3.825-6.276, P<0.01). Conclusions The available evidence suggests that ERAS pathways may reduce the length of postoperative hospital stay in gynaecologic surgery, without increasing complications, while shortening the time needed for postoperative functional recovery.

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“…[2][3][4] Implementation of the Enhanced Recovery After Surgery (ERAS) protocol in gynecologic surgery has yielded significant reductions in length of hospitalization and associated costs. 2, [5][6][7][8][9][10] The new accepted standard among gynecologic surgeons is to allow for discharge in the same day or in less than 23 hours following laparoscopic hysterectomy. 6,11 However, nationwide implementation of ERAS protocols, including at our institution, have not been established, and the incidence and specific predictors of prolonged hospitalization at our institution are not known.…”

Section: Introductionmentioning

confidence: 99%

Factors that Lengthen Patient Hospitalizations Following Laparoscopic Hysterectomy

Ramirez-Caban

Kannan

Goggins

et al. 2020

JSLS

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Objective: To establish descriptive observations associated with prolonged hospitalization after laparoscopic hysterectomy prior to the implementation of a department-wide Enhanced Recovery After Surgery protocol. Methods: A retrospective cohort study at three academic affiliated hospitals in the southeastern United States was conducted evaluating length of hospitalization by patient, surgical, and physician factors for 384 patients who underwent total laparoscopic hysterectomy, laparoscopic assisted vaginal hysterectomy, and robotic assisted total laparoscopic hysterectomy for benign conditions by general and subspecialized gynecologists from 2010 to 2015. Results: Among 384 patients, 19.5% experienced prolonged hospitalization, defined as greater than one day. After adjusting for covariates, robotic assisted total laparoscopic hysterectomy (aOR 3.13), dietary restrictions on postoperative day 1 (aOR 4.42), postoperative nausea or vomiting (aOR 2.01), and postoperative complications (aOR 3.58) were associated with prolonged hospitalization. Conclusion: Data from this study were collected prior to implementation of department-wide enhanced recovery after surgery protocols and highlights areas for improvement. Implementation of specific aspects of these protocols, including aggressive prevention of postoperative nausea and vomiting and early feeding, are easily made changes which may help to effectively decrease length of stay after laparoscopic hysterectomy. Patient and provider education on enhanced recovery protocols is also key to reducing length of stay.

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Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery

Cited by 33 publications

References 18 publications

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Enhanced Recovery After Surgery (ERAS) in Gynaecology: a meta-analysis

Factors that Lengthen Patient Hospitalizations Following Laparoscopic Hysterectomy

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