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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Surgery 1/2017

Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center

Zeitschrift:
BMC Surgery > Ausgabe 1/2017
Autoren:
Eric Lambaudie, Alexandre de Nonneville, Clément Brun, Charlotte Laplane, Lam N’Guyen Duong, Jean-Marie Boher, Camille Jauffret, Guillaume Blache, Sophie Knight, Eric Cini, Gilles Houvenaeghel, Jean-Louis Blache
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12893-017-0332-9) contains supplementary material, which is available to authorized users.

Abstract

Background

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).

Methods

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.

Results

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.

Conclusion

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.
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