49 Effect of enhanced recovery protocol in urogynecologic surgery

Abstract

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based, multidisciplinary and outcome-driven measures developed to provide best practice guidelines for surgical care. Limited data exists to support conventional perioperative interventions of caloric restriction, prolonged immobilization, and liberal administration of fluids and opioids. ERAS protocols for urogynecologic populations are being adopted with limited population and procedure-specific outcome data. Our primary aim was to compare opioid use by patients undergoing major pelvic organ prolapse (POP) surgery before and after implementation of an ERAS protocol. Secondary aims included comparing length of stay and 30-day follow-up characteristics. This ambispective cohort study included a retrospective, pre-ERAS cohort of consecutive patients who underwent major POP surgery starting January 2016. A comprehensive ERAS protocol was implemented in October 2019 (Table 1). A prospective, ERAS cohort consisted of consecutive patients undergoing POP surgery starting in January 2020, 3 months after full implementation of the ERAS protocol. ERAS patients were screened for eligibility and enrolled on the day of surgery. Major POP surgery was defined as including an apical procedure. Demographic and clinical data were abstracted. Descriptive statistics were used for demographic variables. Opioid use was converted to morphine milligram equivalents (MME) and compared between cohorts using the t-test. Other outcomes were compared between groups using t-test or Chi-Square as appropriate. Participants (33 pre-ERAS, 32 ERAS) were similar between cohorts and had mean (SD) age 62.4 (9.7) years, body-mass index 28.9 (4.8) kg/m2, and median (IQR) parity 3 (2-4). Similarly, medical co-morbidities and type of apical POP procedure did not differ between groups. Following ERAS implementation, mean total intra- and post-operative MME decreased (59.4 (31.6) vs 36.6 (20.5), P<0.01). Total discharge prescription MME also decreased (392.3 (88.4) vs 94.6 (61.3), P<0.01). Despite decreased opioid use, post-operative pain scores were not different between groups (Table 2). The ERAS cohort had decreased length of stay and were more likely to be discharged on the day of surgery. Mean number of telephone calls within 30 days of surgery increased (1.0 (1.0) to 2.2 (1.9), P<0.01) while clinic visits, emergency room visits and readmissions did not differ. Implementation of an ERAS protocol in women undergoing major POP surgery resulted in decreased opioid use and length of stay without impacting post-operative pain scores.View Large Image Figure ViewerDownload Hi-res image Download (PPT)