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Obstet Gynecol. 2018 Aug;132(2):281-290. doi: 10.1097/AOG.0000000000002735.

Effect of an Enhanced Recovery After Surgery Program on Opioid Use and Patient-Reported Outcomes.

Author information

1
Departments of Gynecologic Oncology and Reproductive Medicine, Anesthesiology and Perioperative Medicine, Biostatistics, and Symptom Research, and the Division of Pharmacy, the University of Texas MD Anderson Cancer Center, Houston, Texas; Tennessee Oncology, Nashville, Tennessee; and the University of Tennessee Health Sciences Center, Memphis, Tennessee.

Abstract

OBJECTIVE:

To investigate the effect of an enhanced recovery after surgery (ERAS) program on perioperative outcomes with an emphasis on opioid consumption and patient-reported outcomes in the immediate and extended postoperative periods.

METHODS:

We initiated our ERAS program as part of a quality improvement initiative in November 2014. We compared clinical outcomes among a cohort of 607 women undergoing open gynecologic surgery before or after implementation of ERAS. For 293 patients, patient-reported outcomes were compared using the MD Anderson Symptom Inventory-Ovarian Cancer.

RESULTS:

Median age was 58 years (range 18-85 years). Median length of stay decreased by 25% for patients in the ERAS pathway (P<.001). Overall, patients in the ERAS group had a 72% reduction in median opioid consumption and 16% were opioid-free during admission up to postoperative day 3 (P<.001). There was no difference in pain scores (P=.80). Patients on ERAS reported less fatigue (P=.01), interference with walking (P=.003), and total interference (composite score of physical and affective measures) during hospitalization (P=.008). After discharge, those on the ERAS pathway demonstrated a significantly shorter median time to return to no or mild fatigue (10 vs 30 days, P=.03), mild or no interference with walking (5 vs 13 days, P=.003), and mild to no total interference (3 vs 13 days, P=.02). There were no significant differences in complications, rates of readmission, or reoperation between the pre- and post-ERAS groups.

CONCLUSION:

Implementation of an ERAS program was associated with significantly decreased opioid use after surgery and improvement in key patient-reported outcomes associated with functional recovery after surgery without compromising pain scores.

PMID:
29995737
PMCID:
PMC6245646
[Available on 2019-08-01]
DOI:
10.1097/AOG.0000000000002735

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