A Full Enhanced Recovery after Surgery Program in Gynecologic Laparoscopic Procedures: A Randomized Controlled Trial

Abstract

To assess whether a full enhanced recovery after surgery (ERAS) program can further improve perioperative outcomes among patients undergoing gynecologic laparoscopic procedures relative to those receiving limited ERAS management. Randomized controlled trial. Tertiary hospital, China: December 2018 to October 2019. Total of 144 women scheduled for simple elective gynecologic laparoscopic surgery. The participants were randomized into 2 groups: full ERAS intervention or limited ERAS management (without preoperative carbohydrate loading or total intravenous anesthesia or opiate-sparing multimodal analgesia). The primary outcome was postoperative length of stay (LOS), and the secondary outcomes included postoperative pain, time to postoperative milestones, morbidity, and in-hospital cost. Postoperative LOS for the full ERAS program showed a 1-day reduction in comparison with the limited ERAS group (median of 1.0 day vs 2.0 days, respectively; p = .001). Multivariate regression analysis identified preoperative carbohydrate loading and opioid-sparing analgesia as the independent factors for discharging on postoperative day 1. Patients in the full ERAS program reported less pain within 72 hours after surgery and had a lower narcotic consumption rate compared with those in the limited ERAS management. They also enjoyed better and faster recovery as demonstrated by the Quality of Recovery-15 scale on postoperative day 3: 137.0 (interquartile range, 126.3-141.0) for full ERAS program vs 130.0 (23.5-139.0) for limited ERAS management, respectively (p = .030). There were no significant differences between the groups regarding postoperative 30-day morbidity, readmission rate, or in-hospital cost. The addition of full ERAS management can further reduce postoperative LOS and improve patients' quality of life after laparoscopic surgery for gynecologic diseases.