Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study

Miller, Elizabeth C.; McIsaac, Daniel I.; Chaput, A; Antrobus, Jonathan; Shenassa, Hassan; Lui, Anne

doi:10.1007/s12630-015-0347-6

Cited by 19 publications

(11 citation statements)

References 30 publications

(32 reference statements)

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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%

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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Section: Meta-analysismentioning

confidence: 99%

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

Song

Wang

Zhang

et al. 2020

Preprint

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“…Although minimally invasive hysterectomies and enhanced recovery protocols have decreased inpatient stays considerably, most women undergoing hysterectomy still stay longer than 1 inpatient day (29,30). Differences are magnified when comparing time to return to work.…”

Section: Commentmentioning

confidence: 99%

Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis

Barnard

Abdelmagied

Vaughan

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Uterine fibroids are a common problem for reproductive-aged women, yet little comparative effectiveness research is available to guide treatment choice. Uterine artery embolization and magnetic resonance imaging–guided focused ultrasound surgery are minimally invasive therapies approved by the United States Food and Drug Administration for treating symptomatic uterine fibroids. The Fibroid Interventions: Reducing Symptoms Today and Tomorrow study is the first randomized controlled trial to compare these 2 fibroid treatments. (NCT00995878, clinicaltrials.gov) Objective To summarize treatment parameters and compare recovery trajectory and adverse events in the first 6 weeks after treatment. Study Design Premenopausal women with symptomatic uterine fibroids seen at 3 US academic medical centers were enrolled in the randomized controlled trial (n=57). Women meeting identical criteria who declined randomization but agreed to study participation were enrolled in a nonrandomized parallel cohort (n=34). The 2 treatment groups were analyzed by using a comprehensive cohort design. All women undergoing focused ultrasound and uterine artery embolization received the same postprocedure prescriptions, instructions, and symptom diaries for comparison of recovery in the first 6 weeks. Return to work and normal activities, medication use, symptoms, and adverse events were captured with postprocedure diaries. Data were analyzed using the Wilcoxon rank sum test or χ2 test. Multivariable regression was used to adjust for baseline pain levels and fibroid load when comparing opioid medication, adverse events, and recovery time between treatment groups because these factors varied at baseline between groups and could affect outcomes. Adverse events were also collected. Results Of 83 women in the comprehensive cohort design who underwent treatment, 75 completed postprocedure diaries. Focused ultrasound surgery was a longer procedure than embolization (mean [SD], 405 [146] vs 139 [44] min; P<.001). Of women undergoing focused ultrasound (n=43), 23 (53%) underwent 2 treatment days. Immediate self-rated postprocedure pain was higher after uterine artery embolization than focused ultrasound (median [interquartile range], 5 [1–7] vs 1 [1–4]; P=.002). Compared with those having focused ultrasound (n=39), women undergoing embolization (n=36) were more likely to use outpatient opioid (75% vs 21%; P<.001) and nonsteroidal anti-inflammatory medications (97% vs 67%; P<.001) and to have a longer median (interquartile range) recovery time (days off work, 8 [6–14] vs 4 [2–7]; P<.001; days until returned to normal, 15 [10–29] vs 10 [10–15]; P=.02). There were no significant differences in the incidence or severity of adverse events between treatment arms; 86% (42/49) of adverse events required only observation or nominal treatment, and no events caused permanent sequelae or death. After adjustment for baseline pain and uterine fibroid load, uterine artery embolization was still significantly associated with higher opioid use and lon...

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“…98-100 Among patients undergoing vaginal hysterectomy with or without pelvic organ prolapse surgery, ERP is associated with decreased length of stay and cost savings. 10,11,101 An interesting study in this population also found that ERPs are associated with decreased nursing time required for patient care.…”

Section: Erp In Gynecology and Gynecologic Oncologymentioning

confidence: 99%

Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology

Barber

2015

Obstetrical &Amp; Gynecological Survey

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Importance Enhanced recovery programs (ERPs) are considered standard of care across a variety of surgical disciplines, but ERPs have not been widely adopted in gynecology. Objective To describe ERP principles and the role of ERPs in gynecology and gynecologic oncology. Evidence Acquisition Comprehensive literature search performed using MEDLINE, the Cochrane Collaboration Database, and PubMed. Results Meta-analyses of a substantial number of randomized-controlled trials have shown that implementation of ERP protocols is associated with decreased length of hospital stay, a decrease in rates of postoperative complication, decreased morbidity, and cost savings while preserving patient satisfaction and quality of life. Conclusions and Relevance High quality evidence exists for improved outcomes among patients in ERPs. ERPs save resources and costs across the health care system. As quality metrics and bundled payments increase in healthcare, ERPs will have increasing prominence.

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Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study

Cited by 19 publications

References 30 publications

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

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

Periprocedural outcomes comparing fibroid embolization and focused ultrasound: a randomized controlled trial and comprehensive cohort analysis

Enhanced Recovery Pathways in Gynecology and Gynecologic Oncology

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