Enhanced recovery programme in gynaecology: outcomes of a hysterectomy care pathway

Abstract

There was a wide variation in the peri-operative management of women undergoing hysterectomy for both benign and malignant disease at Southend University Hospital NHS Foundation Trust prior to 2010. The median length of stay following a hysterectomy and more radical gynaecological oncology surgery was five days and seven days respectively. The NHS East of England Strategic Health Authority commissioned the development of Enhanced Recovery Programme (ERP) in various surgical specialties including gynaecology and the pathway was implemented from 2012 onward.Dedicated specialist nurses collected data prospectively. The median length of stay was shortened to three days. This difference was statistically significant with a P value = 0.0001. We describe the successful implementation of an ERP in Southend Hospital resulting with no difference in measurable morbidity and mortality, a shorter length of stay, and a high patient satisfaction scores and outcomes.

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

“…Overall, the response to the ERAS protocol was positive for open, laparoscopy, and vaginal surgery. Patient satisfaction was high in all studied aspects of perioperative care for the ERAS groups, including patient education, quality of care during hospitalization, pain management, coordination of care, and discharge process, but no scores were available for the historical control subjects [12,17,27]. For Kalogera et al [27] the lowest satisfaction was regarding PONV, with only 87% rating it as excellent or very good.…”

“…All studies evaluating open benign hysterectomies noted a decrease in LOS [12−18]. Mukhopadhyay [12] demonstrated that over time LOS continued to decrease after implementation of an ERAS protocol for open hysterectomies. Median LOS was 5 days before institution of ERAS and then decreased to 4 days in the first year and to 3 days in the second year.…”

“…The rate of readmission for laparoscopic surgery was 0 to 7% [14,33,[35][36][37][38]41,54,55]. The open surgery rate was 1.2% to 4% [12,[19][20][21][22]28,55]. Readmission rates for cancer cases were slightly higher at 1.2% to 12% [17−20,23 −25,29−31,40,42,43,51].…”

“…For Kalogera et al [27] the lowest satisfaction was regarding PONV, with only 87% rating it as excellent or very good. Mukhopadhyay [12] reported a 71.4% response rate (100 of 140) with 75% answering positively and <5% responding as unsure or negatively.…”

Comparison of enhanced recovery protocol with conventional care in patients undergoing minor gynecologic surgery.

“…Results derived from an observational study conducted by Wijk et al revealed that implementation of ERAS protocol leads to a significant increase in the number of patients discharged within 2 days after the surgery [23]. Similarly, Mukhopadhyay reported that in patients undergoing open hysterectomies, LOS decreased from 5 days to 3 days with the implementation of ERAS protocols [24]. Ottensen et al showed that median LOS following vaginal surgery performed for utero-vaginal prolapse was also significantly lower in patients receiving ERAS protocols compared to those receiving conventional care [25].…”