The online version of this article (https://doi.org/10.1186/s12893-017-0332-9) contains supplementary material, which is available to authorized users.
Enhanced Recovery After Surgery Programs (ERP) includes multimodal approaches of perioperative patient’s clinical pathways designed to achieve early recovery after surgery and a decreased length of hospital stay (LOS).
This observational study evaluated the implementation of ERP in gynaecologic oncological surgery in a minimally invasive techniques (MIT) expert center with more than 85% of procedures done with MIT. We compared a prospective cohort of 100 patients involved in ERP between December 2015 and June 2016 to a 100 patients control group, without ERP, previously managed in the same center between April 2015 and November 2015. All the included patients were referred for hysterectomy and/or pelvic or para-aortic lymphadenectomy for gynaecological cancer. The primary objective was to achieve a significant decrease of median LOS in the ERP group. Secondary objectives were decreases in proportion of patients achieving target LOS (2 days), morbidity and readmissions.
Except a disparity in oncological indications with a higher proportion of endometrial cancer in the group with ERP vs. the group without ERP (42% vs. 22%; p = 0.003), there were no differences in patient’s characteristics and surgical procedures. ERP were associated with decreases of median LOS (2.5 [0 to 11] days vs. 3 [1 to 14] days; p = 0.002) and proportion of discharged patient at target LOS (45% vs. 24%; p = 0.002). Morbidities occurred in 25% and 26% in the groups with and without ERP and readmission rates were respectively of 6% and 8%, without any significant difference.
ERP in gynaecologic oncological surgery is associated with a decrease of LOS without increases of morbidity or readmission rates, even in a center with a high proportion of MIT. Although it is already widely accepted that MIT improves early recovery, our study shows that the addition of ERP’s clinical pathways improve surgical outcomes and patient care management.
Borendal Wodlin N, Nilsson L, Kjølhede P. GASPI study group. The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial. BJOG Int. J Obstet Gynaecol. 2011;118:299–308. CrossRef
Minig L, Chuang L, Patrono MG, Fernandez-Chereguini M, Cárdenas-Rebollo JM, Biffi R. Clinical outcomes after fast-track care in women undergoing laparoscopic hysterectomy. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2015;131:301–4. CrossRef
Bruneau L, Randet M, Evrard S, Damon A, Laurent F-X. Total laparoscopic hysterectomy and same-day discharge: satisfaction evaluation and feasibility study. J Gynécologie Obstétrique Biol Reprod. 2015;44:870–6. CrossRef
Chase DM, Lopez S, Nguyen C, Pugmire GA, Monk BJ. A clinical pathway for postoperative management and early patient discharge: does it work in gynecologic oncology? Am J Obstet Gynecol. 2008;199:541.e1–7. CrossRef
Wijk L, Franzén K, Ljungqvist O, Nilsson K. Enhanced recovery after surgery protocol in abdominal hysterectomies for malignant versus benign disease. Gynecol Obstet Investig. 2016;81:461–7. CrossRef
Kalogera E, Dowdy SC. Enhanced recovery pathway in gynecologic surgery: improving outcomes through evidence-based medicine. Obstet Gynecol Clin N Am. 2016;43:551–73. CrossRef
de Groot JJ, Maessen JM, Slangen BF, Winkens B, Dirksen CD, van der Weijden T. A stepped strategy that aims at the nationwide implementation of the enhanced recovery after surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial. Implement Sci IS. 2015;10:106. CrossRefPubMed
FKY W, So C, Chau J, AKP L, SKF T, McGhee S. Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support. Age Ageing. 2015;44:143–7. CrossRef
Schiavone MB, Herzog TJ, Ananth CV, Wilde ET, Lewin SN, Burke WM, et al. Feasibility and economic impact of same-day discharge for women who undergo laparoscopic hysterectomy. Am J Obstet Gynecol. 2012;207:382.e1–9. CrossRef
Philp S, Carter J, Pather S, Barnett C, D’Abrew N, White K. Patients’ satisfaction with fast-track surgery in gynaecological oncology. Eur J Cancer Care (Engl). 2015;24:567–73. CrossRef
- Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center
Alexandre de Nonneville
Lam N’Guyen Duong
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II