EP192/#270 Enhanced recovery after surgery for gynecologic oncology patients undergoing laparotomy during the COVID-19 pandemic

Abstract

Objectives Enhanced recovery after surgery (ERAS) is an evidence-based surgical quality improvement program that has been shown to improve patient outcomes, while reducing overall resource costs. The aim of this study was to evaluate the impact of implementation of ERAS for gynecologic oncology patients undergoing laparotomy during the COVID-19 pandemic. Methods We conducted a pre-post study that included women admitted for gynecological oncology abdominal surgery. Outcomes of interest included post-operative LOS, readmission, and return to ED within 30 days of discharge. Outcomes were compared for the pre (June 2019-June 2020) and post (July 2020-June 2021) intervention periods, using Chi-square for categorical variables and t-test for continuous variables. Results A total of 364 patients were included, among whom 217 were admitted in the pre and 147 were admitted in post intervention period. It was observed that patients had higher BMI (p<0.01), higher ASA category (p=0.71), and higher Charlson comorbidity index (p=0.07) in the post compared with pre intervention period. There was a trend towards decreasing mean post-operative LOS from 104.1 to 91.4 hours (p=0.12). However, there was a slight non-significant increase in hospital readmission from 6.0% to 8.2% (p=0.42), with no notable differences in ED visits (13.8% to 12.9%, p=0.81). Conclusions Despite the challenges associated with the COVID-19 pandemic, including delays in surgical care access and associated increase in patient morbidity, we were able to successfully implement ERAS as routine medical care for gynecologic oncology patients. Future directions include auditing compliance and in-depth cost analysis.