• Larissa A Meyer, Javier Lasala, Maria D Iniesta, Alpa M Nick, Mark F Munsell, Qiuling Shi, Xin Shelley Wang, Katherine E Cain, Karen H Lu, and Pedro T Ramirez.
• 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.
• Obstet Gynecol. 2018 Aug 1; 132 (2): 281-290.

ObjectiveTo 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.MethodsWe 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.ResultsMedian 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.ConclusionImplementation 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.

31 keywords...

hide…