ERAS Implementation in Gynecologic Surgery in a Medically Underserved Publicly Insured and Uninsured Population

Abstract

Study Objective Enhanced recovery after surgery (ERAS) protocols have been shown to improve patient outcomes and reduce post-operative length of stay. In our underserved population, patients experience a high incidence of comorbid conditions, lack adequate insurance, and face many barriers to healthcare that adversely affect health outcomes. We investigated the impact of an ERAS protocol implementation in our publicly insured and uninsured high-risk patient population undergoing gynecologic surgery and assessed hospital length of stay (LOS), 30 day hospital readmission rates, and pain scores. Design IRB approval was obtained. Data was abstracted from medical records pre (1/1/18-2/28/19) and post (3/1/19-2/29/20) ERAS implementation. LOS, readmission Setting The study took place in an urban hospital setting. Patients or Participants Patients undergoing gynecologic surgery during the study period with public insurance/free care were included (N=509). Interventions Implementation of ERAS protocol included pre-operative carbohydrate loading, intra-operative euvolemia, scheduled post-operative nausea and non-opioid pain medications, and early ambulation. Measurements and Main Results Implementation of ERAS led to decreased length of stay 1.8 vs 1.43 days (p-value = 0.006); however, when adjusted for potential confounders this was no longer statistically significant. Average pain scores significantly decreased with ERAS implementation 3.06 pre-ERAS vs 2.44 post-ERAS (p-value = 0.005) and this held true when adjusted for potential confounders. Hospital readmission rates did not change significantly with ERAS implementation 8% pre-ERAS vs 10% post-ERAS (p-value = 0.538). Conclusion This is the first study to assess the impact of ERAS on our patient population, a diverse and medically underserved population of women undergoing gynecologic surgery. ERAS improved pain scores without adversely affecting hospital length of stay in this population. Our next steps are to better understand the impact of ERAS on opioid use among this patient population as well as assessing its impact on patient satisfaction in this population.