Enhanced Recovery after Surgery is Feasible and Beneficial and Should Be the Standard in Major Gynecological Surgeries

• Published in: The Israel Medical Association journal Vol. 23; no. 11; pp. 725 - 730
• Main Authors: Kugelman, Nir, Lavie, Ofer, Cohen, Nadav, Schmidt, Meirav, Reuveni, Amit, Ostrovsky, Ludmila, Dabah, Hawida, Segev, Yakir
• Format: Journal Article
• Language: English
• Published: Israel 01-11-2021
• Subjects: Analgesics, Opioid - therapeutic use; Clinical Protocols; Cost-Benefit Analysis; Enhanced Recovery After Surgery - standards; Female; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - methods; Gynecologic Surgical Procedures - rehabilitation; Humans; Israel - epidemiology; Laparoscopy - adverse effects; Laparoscopy - methods; Laparoscopy - rehabilitation; Length of Stay - statistics & numerical data; Middle Aged; Outcome and Process Assessment, Health Care; Patient Readmission - statistics & numerical data; Postoperative Complications - economics; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Israel
• ISSN: 1565-1088

Enhanced recovery after surgery (ERAS) protocols are evidence-based protocols designed to standardize medical care, improve outcomes, and lower healthcare costs.
To evaluate the implementation of the ERAS protocol and the effect on recovery during the hospitalization period after gynecological laparotomy surgeries.
We compared demographic and clinical data of consecutive patients at a single institute who underwent open gynecological surgeries before (August 2017 to December 2018) and after (January 2019 to March 2020) the implementation of the ERAS protocol. Eighty women were included in each group.
The clinical and demographic characteristics were similar among the women operated before and after implementation of the ERAS protocol. Following implementation of the protocol, decreases were observed in post-surgical hospitalization (from 4.89 ± 2.56 to 4.09 ± 1.65 days, P = 0.01), in patients reporting nausea symptoms (from 18 (22.5%) to 7 (8.8%), P = 0.017), and in the use of postoperative opioids (from 77 (96.3%) to 47 (58.8%), P < 0.001). No significant changes were identified between the two periods regarding vomiting, 30-day re-hospitalization, and postoperative minor and major complications.
Implementation of the ERAS protocol is feasible and was found to result in less postoperative opioid use, a faster return to normal feeding, and a shorter postoperative hospital stay. Implementation of the protocol implementation was not associated with an increased rate of complications or with re-admissions.