The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

Mendivil, Alberto A.; Busch, Justin R.; Richards, David C.; Vittori, Heather; Goldstein, Bram H.

doi:10.1097/igc.0000000000001198

Cited by 23 publications

(12 citation statements)

References 20 publications

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“…Our reported improvement in LOS and postoperative complication rate is also in keeping with the findings of a majority of ERAS retrospective studies in gynecologic oncology 15,20,30‐34 . Marx et al reported reduced LOS, from 7.3 days to 5.4 days ( P < .05), and decreased severe medical complications, from 14% to 2% ( P < .01), with their fast‐track rehabilitation program after ovarian malignancy surgery 35 .…”

Section: Discussionsupporting

confidence: 89%

“…In the Canadian context, the net cost saving.s per patient was CAD$956 15 . In the American setting, savings ranged from US$2572 to US$7600 per patient, 20,32 and from a 15% to 25% reduction in cost overall 44,45 …”

Section: Discussionmentioning

confidence: 99%

“…Apart from clinical benefits, there are also significant health system benefits that can be achieved with the successful implementation of the Enhanced Recovery pathways: ERAS implementation in gynecologic oncology has been shown to create important healthcare cost savings. 15,32,[43][44][45] In the Canadian context, the net cost saving.s per patient was CAD$956. 15 In the American setting, savings ranged from US$2572 to US$7600 per patient, 20,32 and from a 15%…”

Section: Discussionmentioning

confidence: 99%

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Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

Bernard

McGinnis

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The purpose of the study is to evaluate the impact of an enhanced recovery after surgery (ERAS) program implemented in a Gynecologic Oncology population undergoing a laparotomy at a Canadian tertiary care center. Material and methods Prospectively collected data, using the American College of Surgeons’ National Surgical Quality Improvement Program dataset (ACS NSQIP), was used to compare 30‐day postoperative outcomes of gynecologic oncology patients undergoing a laparotomy before and after the 2018 implementation of an ERAS program in a Canadian regional cancer center. Patient demographics, surgical variables and postoperative outcomes of 187 patients undergoing surgery in 2019 were compared with those of 441 patients undergoing surgery between January 2016 and December 2017. Student’s t, Mann‐Whitney U and Chi‐square tests, as well as multivariate linear and logistic regressions were used to evaluate baseline characteristics and 30‐day postoperative complications. Results Length of stay was significantly shortened in the study population after introducing the ERAS protocol, from a mean of 4.7 (SD = 3.8) days to a mean of 3.8 (SD = 3.2) days (P = .0001). The overall complication rate decreased from 24.3% to 16% (P = .02). Significant decreases in the rates of postoperative infections (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.31‐0.99) and cardiovascular complications (adjusted OR 0.27, 95% CI 0.09‐0.79) were noted, without a significant increase in readmission rate (adjusted OR 0.50, 95% CI 0.21‐1.07). Conclusions Introducing an ERAS program for gynecologic oncology patients undergoing laparotomy was effective in shortening length of stay and the overall complication rate without a significant increase in readmission. Advocacy for broader implementation of ERAS among gynecologic oncology services and ongoing discussion on challenges and opportunities in the implementation process are warranted to improve patient outcomes and experiences.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

Bernard

McGinnis

et al. 2020

Acta Obstet Gynecol Scand

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“…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]. The amount of intraoperative fluid intake and total fluid intake was also shown to be decreased with the implementation of the ERAS protocol in women operated on for gynecologic cancer [26].…”

Section: Discussionmentioning

confidence: 99%

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

Yılmaz

Akça

Katılmış

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: Data regarding the role of the enhanced recovery after surgery (ERAS) protocol in improving postoperative outcomes and postoperative compliance in patients undergoing gynecological surgery, in particular, minor laparoscopic and hysteroscopic gynecological procedures, are limited. Aim: To investigate the impact of the ERAS protocol on time to ambulation, length of stay (LOS), readmissions and postoperative complications in patients undergoing minor gynecological surgical procedures. Material and methods: A total of 104 patients undergoing minor laparoscopic and hysteroscopic gynecological procedures were randomized to the ERAS protocol or conventional care. Time to defecation, ambulation, and solid food intake, bleeding and LOS were recorded for each patient. Results: The amount of intravenous fluid administered in the perioperative (p < 0.001) and postoperative period (p < 0.001) was significantly higher in the conventional care group than in the ERAS group. In addition, time to first defecation (p < 0.001), time to eating solid food (p < 0.001), and time to ambulation (p = 0.008) were shorter in the ERAS group compared to the conventional care group. Length of stay was also significantly shorter in the ERAS group than in the conventional care group (p < 0.001). Conclusions: Implementation of ERAS protocols provides shorter LOS, less fluid intake, early return of bowel function and early mobilization without an increase in complication rate in women undergoing minor laparoscopic or hysteroscopic gynecologic surgery.

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“…Based on cost data collected in trials of the enhanced recovery approach for colorectal and gynecologic surgery, it appears that the implementation of an ERAS protocol can lead to savings of US$2200-$2500 per patient treated. 77,78 The authors of an economic evaluation of the ERAS multi-site colorectal surgery program in Alberta estimated that every $1 invested in the ERAS protocol delivered a savings of $3.8 (range $2.4-$5.1) in return. 79 Further evaluation of ERAS protocols and implementation are necessary to continue assessing the true effect of cost and length of stay.…”

Section: Is Implementing An Eras Protocol Cost-effective?mentioning

confidence: 99%

Enhanced recovery after surgery: implementing a new standard of surgical care

Altman

Helpman

McGee

et al. 2019

CMAJ

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The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

Cited by 23 publications

References 20 publications

Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

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

Enhanced recovery after surgery: implementing a new standard of surgical care

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