Fast-track protocol for perioperative care in gynecological surgery: Cross-sectional study

Uyeda, Maria Gabriela Baumgarten Kuster; Girão, Manoel Joâo Batista Castello; Carbone, Ébe dos Santos Monteiro; Fonseca, Marcelo Cunio Machado; Takaki, Mayara Ronzini; Sartori, Marair Grácio Ferreira

doi:10.1016/j.tjog.2019.02.010

Cited by 8 publications

(10 citation statements)

References 14 publications

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“…In terms of length of stay, our results are in agreement with those found in other FT protocols in gynecological surgery. In a study by Kuster Uyeda et al ( 29 ) on a FT protocol for perioperative care in general gynecological surgery, the hospitalization time was significantly reduced by 5.5 h. A possible explanation for the shorter hospital stay could have been a diminished post-operative pain; however, our study showed a non-significant reduction in the mean VAS pain score of 10% in the FT group compared with the usual care group on the day of surgery and no difference in the reported pain on post-operative day 1. Other studies have shown similar effects of FT protocols on pain, suggesting that the key to a reduced hospital stay is the well-codified multimodal approach in the FT protocol rather than one specific element ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes

et al. 2021

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Study Objective: Evaluate the effects of a fast-track (FT) protocol on costs and post-operative recovery.Methods: One hundred and seventy women undergoing total laparoscopic hysterectomy for a benign indication were randomized in a FT protocol or a usual care protocol. A FT protocol included the combination of minimally invasive surgery, analgesia optimization, early oral refeeding and rapid mobilization of patients was compared to a usual care protocol. Primary outcome was costs. Secondary outcomes were length of stay, post-operative morbidity and patient satisfaction.Main Results: The mean total cost in the FT group was 13,070 ± 4,321 Euros (EUR) per patient, and that in the usual care group was 3.5% higher at 13,527 ± 3,925 EUR (p = 0.49). The FT group had lower inpatient surgical costs but higher total ambulatory costs during the first post-operative month. The mean hospital stay in the FT group was 52.7 ± 26.8 h, and that in the usual care group was 20% higher at 65.8 ± 33.7 h (p = 0.006). Morbidity during the first post-operative month was not significantly different between the two groups. On their day of discharge, the proportion of patients satisfied with pain management was similar in both groups [83% in FT and 78% in the usual care group (p = 0.57)]. Satisfaction with medical follow-up 1 month after surgery was also similar [91% in FT and 88% in the usual care group (p = 0.69)].Conclusion: Implementation of a FT protocol in laparoscopic hysterectomy for benign indications has minimal non-significant effects on costs but significantly reduces hospital stay without increasing post-operative morbidity nor decreasing patient satisfaction.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04839263.

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Section: Discussionmentioning

confidence: 99%

Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes

et al. 2021

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“…Routine nursing is the most widely used nursing mode in clinical nursing work, but it is only a simple intervention on the patient's condition, lifestyle, treatment and other aspects, lacking specificity and comprehensiveness. While perioperative nursing has a more in-depth communication with patients on the basis of routine nursing [17], so that patients can have a detailed understanding of their own condition, surgery, complications, etc. This helps patients to overcome the fear and anxiety of surgery, and at the same time, early intervention measures will be taken for high-risk groups with DVT.…”

Section: Discussionmentioning

confidence: 99%

Effect of Perioperative Nursing on the Prevention of Lower Extremity Deep Vein Thrombosis in Patients Undergoing Gynecological Pelvic Surgery

Mo¹,

Liao²,

Cai³

2020

AJNS

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Background: Deep venous thrombosis (DVT) is a common complication of gynecological pelvic surgery. DVT focuses on prevention. How to make a detailed perioperative nursing plan and organize its implementation of the measures is a great significance for the prevention of DVT in patients undergoing gynecological pelvic surgery. Objective: To investigate the effect of perioperative nursing intervention measures on the prevention of lower extremity deep vein thrombosis (DVT) in patients undergoing pelvic surgery in gynecology. Methods: Set up a project improvement activity group, analyzation the reason of gynecological pelvic surgery patients with DVT, and development a detailed plan of perioperative nursing intervention measures. Organizing the implementation of "one-on-one" nursing intervention, the problems in the nursing process were collected and formulated solutions, inspection gaps in care, made up the nursing error and improved nursing content. It was used to improve the quality of preventive measures and promote their implementation by "plan-do-check-action" (PDCA) cycle. Results: The perioperative preventive measures were continuously improved with PDCA cycle. The incidence of DVT in patients with pelvic surgery in our gynecological ward decreased from 6.96% to 2.08%. The anus exhausting time, resumption of eating time, defecation time and first leaving bed time of perioperative nursing group were shorter than before of the project improvement activities. The hospitalization time of patients was also significantly shortened. The differences were statistically significant (P < 0.05). Through the follow-up survey, patients' satisfaction with nursing increased from 82.6% to 95.0%. Conclusion: Through the development of detailed perioperative nursing plan and promotion the implementation of the measures with PDCA cycle continuously improved for the prevention of DVT in patients undergoing gynecological pelvic surgery, the incidence of postoperative lower extremity DVT could be effectively reduced and also promote the rehabilitation of postoperative. It was significantly shortened in the hospitalization time of patients, and improved the satisfaction of patients in perioperative nursing.

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“…(12)(13)(14)(15)22,25,58,59) A despeito destes resultados, evidente atraso na adoção destas novas práticas, baseadas em evidências científicas, nos diferentes serviços de ginecologia no Brasil são observadas. (19) Em nosso meio, poucos estudos descrevem a implantação de protocolos de rápida recuperação pós-operatória na ginecologia. Este estudo é pioneiro na avaliação dos desfechos clínicos e de custos após a instituição do Protocolo ERAS para pacientes submetidas à histerectomia abdominal por doença benigna em hospital público de ensino no Brasil.…”

Section: Discussionunclassified

“…Em ensaio randomizado, observou-se adesão foi de 98,8% dos participantes (14) e de 88,9%, em outro estudo realizado no Brasil. (19) Como observou-se aumento da frequência do uso da ondansetrona no Grupo ERAS. Estudos notam-se adesão da profilaxia de náuseas e vômitos em mais de 90% e reforça importância desse item para o conforto da paciente e otimização da alta precoce.…”

Section: Discussionunclassified

“…(16)(17)(18) O primeiro estudo da implementação do protocolo de cuidados perioperatórios na ginecologia no Brasil também observou melhora dos desfechos clínicos. (19) Entretanto, o estudo apresenta limitações por incluir dados de todas as modalidades de cirurgias ginecológicas, desde as de pequeno a grande porte, limitando-se a revisão de práticas usuais, e adoção de novas, nas enfermarias e não no centro cirúrgico. Os autores destacam grandes limitações para a implementação das estratégias de programas de recuperação pós-operatória em hospital público.…”

Section: Introductionunclassified

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O impacto nos indicadores de qualidade das histerectomias abdominais com a implementação do protocolo de rápida recuperação pós-operatória em hospital de ensino

Alvarenga‐Bezerra¹

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Dedico este trabalho aos meus pais, incentivadores de todos os meus passos e ao meu esposo pelo apoio incondicional e compreensão, especialmente nos momentos de minha ausência. vi Agradecimentos Agradeço ao meu orientador Prof. Dr. Sérgio Podgaec, grande mestre, grande incentivador da pós-graduação, sempre estimulando a darmos o nosso melhor, um exemplo de dedicação. Agradeço ao meu coorientador Prof. Dr. Renato Moretti, grande idealizador do estudo, exemplo de dedicação, competência e profissionalismo. Sempre me incentivou e me guiou na minha formação profissional e na pós-graduação. Foram anos de muito trabalho e que hoje podemos comemorar o sucesso de tanto esforço. Agradeço à toda equipe do Instituto Israelita de Ensino e Pesquisa do Hospital Israelita Albert Einstein, Equipe administrativa, médicos titulares e residentes, e equipe Multiprofissional do Hospital M'Boi Mirim.Agradeço, imensamente, a todas as pacientes que contribuíram para a pesquisa.

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Fast-track protocol for perioperative care in gynecological surgery: Cross-sectional study

Cited by 8 publications

References 14 publications

Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes

Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes

Effect of Perioperative Nursing on the Prevention of Lower Extremity Deep Vein Thrombosis in Patients Undergoing Gynecological Pelvic Surgery

O impacto nos indicadores de qualidade das histerectomias abdominais com a implementação do protocolo de rápida recuperação pós-operatória em hospital de ensino

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