Predictors of early discharge after open gynecological surgery in the setting of an enhanced recovery after surgery protocol

Wan, King Man; Carter, Jonathan; Philp, Shannon

doi:10.1111/jog.13045

Cited by 12 publications

(15 citation statements)

References 13 publications

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“…Overall, there was a reduction in LOS for open gynecologic cancer surgery [23−27]. A total of 335 patients (73.8%) were successfully discharged on postoperative day 3 after completing the ERAS protocol [28].…”

Section: Open Hysterectomymentioning

confidence: 99%

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

Scheib

Thomassee

Kenner

2019

Journal of Minimally Invasive Gynecology

100

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Enhanced recovery after surgery (ERAS), or "fast-track" protocol, aims to minimize the physiologic stress of surgery and optimize the rehabilitation of patients. However, there is limited data in obstetrics and gynecology. We reviewed the published literature on ERAS programs in gynecology to evaluate the outcomes and potential key elements for a successful program. Fifty studies were evaluated. We recommend preoperative counseling to the patient, no bowel preparation, an opioid-sparing multimodal approach to pain management, goal-directed fluid management, minimally invasive surgery when possible, and early mobilization and feeding. This is a multidisciplinary team effort and requires active patient participation in the process.

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Section: Open Hysterectomymentioning

confidence: 99%

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

Scheib

Thomassee

Kenner

2019

Journal of Minimally Invasive Gynecology

100

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“…Enhanced recovery after surgery (ERAS) has been extensively applied in different fields 1 . Shortening preoperative fasting time and preoperative oral carbohydrate consumption are the core recommendations of ERAS for patients undergoing elective surgeries 2 .…”

Section: Introductionmentioning

confidence: 99%

Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial

Liu

Jin

Wang

et al. 2021

J of Obstet and Gynaecol

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Aim To investigate the safety and feasibility of taking low‐concentration carbohydrate solution at 2 h before induction of anesthesia for gestational diabetes mellitus (GDM) patients. Methods GDM patients undergoing cesarean section were randomly assigned to experimental group (n = 43) and control group (n = 42). Two hours before induction of anesthesia, participants in experimental group orally received 300 mL low‐concentration carbohydrate solution, while those in control group received equivalent warm water. Blood glucose and serum insulin were measured at 2 h before induction of anesthesia, right before induction of anesthesia, and the morning of postoperative day 1. Neonatal blood glucose level was monitored at birth. Maternal gastrointestinal function and well‐being were assessed perioperatively. Results The levels of blood glucose and serum insulin right before induction of anesthesia in the experimental group were significantly higher than those in the control group. There were four cases with hypoglycemia in the experimental group and 19 cases in the control group right before induction of anesthesia (9.3% vs 45.2%, p < 0.001). The incidence of neonatal hypoglycemia was 2.3% in the experimental group and 7.1% in the control group with no significance. Hunger score of the participants between the two groups right before induction of anesthesia was significantly different. No aspiration, nausea, and vomiting occurred in both groups before, during, and after surgery. No significant difference was found in the time to the first flatus and abdominal distension between the two groups. Conclusion Taking low‐concentration carbohydrate solution is safe and feasible for patients with GDM undergoing elective cesarean section.

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“…The ERAS programs can also be referred to as "fast-track surgery," "fast-track pathway," and "clinical pathway" and are a concept initially described by Dr. Kehlet. 1 Recently, the ERAS programs have been shown in many surgical areas, such as urologic surgery, 27 bariatric surgery, 28 liver surgery, 29 gastric surgery, 30 gynecological surgery, 31 and particularly in the field of colorectal surgery, to accelerate recovery and decrease LOS and hospital costs. 32 These pathways encompass all facets of perioperative care, including preoperative planning, intraoperative management, and postoperative care.…”

Section: Discussionmentioning

confidence: 99%

Advancing the Time to the Initiation of Adjuvant Chemotherapy and Improving Postoperative Outcome: Enhanced Recovery after Surgery in Pancreaticoduodenectomy

Wang

Shen

et al. 2020

The American Surgeon

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Early initiation of chemotherapy could improve overall survival after pancreaticoduodenectomy (PD). The concept of enhanced recovery after surgery (ERAS), which aims to reduce the stress response to surgery and accelerate recovery, is relatively limited in PD. The aim of the study was to retrospectively analyze the relationships of ERAS with the time of initiation of postoperative chemotherapy and recovery in PD patients. Between January 1, 2008 and December 31, 2017, all patients who underwent open PD for malignant tumor at our unit were studied retrospectively. Patients were divided into ERAS and conventional groups. The time to initiation of adjuvant chemotherapy and postoperative outcomes were analyzed. There were 344 consecutive patients in this study, with 203 patients in the ERAS group. There were no significant differences between the ERAS and conventional groups in morbidity, mortality, and readmission. The median time of initiation of adjuvant chemotherapy in the ERAS group (54.1 days) was significantly shorter than that of initiation of adjuvant chemotherapy in the conventional group (67.8 days). The ERAS group had a shorter postoperative length of stay than the conventional group (14.9 vs 19.3 days). The ERAS program is safe and feasible in PD. These protocols improve postoperative recovery and advance the time of initiation of adjuvant chemotherapy.

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Predictors of early discharge after open gynecological surgery in the setting of an enhanced recovery after surgery protocol

Abstract: Malignancy, advanced-stage disease, intensive care unit admission, vertical midline incision and perioperative complications are significantly associated with longer hospital stay in patients managed by an ERAS protocol.

Cited by 12 publications

References 13 publications

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

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

Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial

Advancing the Time to the Initiation of Adjuvant Chemotherapy and Improving Postoperative Outcome: Enhanced Recovery after Surgery in Pancreaticoduodenectomy

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