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Int Urogynecol J. 2019 Feb;30(2):313-321. doi: 10.1007/s00192-018-3794-0. Epub 2018 Oct 29.

Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery.

Author information

1
Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA. etrowbridge@virginia.edu.
2
University of Virginia Health System, Charlottesville, VA, 22908, USA. etrowbridge@virginia.edu.
3
Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA.
4
Department of General Surgery, University of Virginia Health System, Charlottesville, VA, USA.
5
Department of Anesthesia, University of Virginia Health System, Charlottesville, VA, USA.

Abstract

INTRODUCTION AND HYPOTHESIS:

Enhanced recovery protocols (ERPs) are evidenced-based interventions designed to standardize perioperative care and expedite recovery to baseline functional status after surgery. There remains a paucity of data addressing the effect of ERPs on pelvic reconstructive surgery patients.

METHODS:

An ERP was implemented at our institution including: patient counseling, carbohydrate loading, avoidance of opioids, goal-directed fluid resuscitation, immediate postoperative feeding and early ambulation. Patients undergoing elective pelvic reconstructive surgery before and after implementation of the ERP were identified in this cohort study.

RESULTS:

One hundred eighteen patients underwent pelvic reconstructive surgery within the ERP compared with 76 historic controls. Reductions were seen in length of hospital stay (29.9 vs. 27.9 h, p = 0.04), total morphine equivalents (37.4 vs. 19.4 mg, p < 0.01) and total intravenous fluids administered (2.7 l vs. 1.5 l, p < 0.0001). Hospital discharges before noon doubled (32.9 vs. 60.2%, p < 0.01). More patients in the ERP group ambulated on the day of surgery (17.1 vs. 73.7%, p < 0.01) and ambulated at least two times the day following surgery (34.2 vs. 72.9%, p < 0.01). No differences were seen in average pain scores (highest pain score 7.39 vs. 7.37, p = 0.95), hospital readmissions (3.9 vs. 3.4%, p = 0.84), or postoperative complications (6.58 vs. 8.47%, p = 0.79). Patient satisfaction significantly improved. ERP was not associated with an increase in 30-day total hospital costs.

CONCLUSIONS:

Implementation of ERP for pelvic reconstructive surgery patients was associated with a reduced length of hospital stay, improved patient satisfaction, and decreased administration of intravenous fluids and opioids without an increase in complications, readmissions, or hospital costs.

KEYWORDS:

ERP; Fast track recovery; Vaginal hysterectomy; Vaginal reconstruction

PMID:
30374533
DOI:
10.1007/s00192-018-3794-0

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