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. 2021 Feb;100(2):353-361.
doi: 10.1111/aogs.14009. Epub 2020 Oct 16.

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

Laurence Bernard  1   2 , Justin M McGinnis  1   2 , Jane Su  3 , Mohammad Alyafi  1   2 , Delia Palmer  2 , Leonard Potts  2 , Kelly-Lynn Nancekivell  2 , Heidi Thomas  2 , Heather Kokus  2 , Lua R Eiriksson  1   2 , Lorraine M Elit  1   2 , Waldo G F Jimenez  1   2 , Clare J Reade  1   2 , Limor Helpman  1   2
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Free article

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

Laurence Bernard et al. Acta Obstet Gynecol Scand. 2021 Feb.
Free article

Abstract

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.

Keywords: enhanced recovery after surgery; gynecologic oncology; gynecologic surgical procedures; neoplasms; laparotomy; outcome assessment.

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References

REFERENCES

    1. Carli F. Considérations physiologiques sur les programmes de Récupération rapide après la chirurgie (RRAC): implications de la réponse au stress. Can J Anesth. 2015;62:110-119.
    1. Scott MJ, ChB M, Miller TE. Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes. Anesthesiol Clin. 2015;33:79-91.
    1. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;(2):CD007635.
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. 2017;152:292-298.
    1. Hu Z-C, He L-J, Chen D, et al. An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis. J Orthop Surg Res. 2019;14:77.

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