Short-term outcomes after an enhanced recovery after surgery protocol in abdominal hysterectomies for leiomyomas in a teaching hospital.

Abstract

To compare the perioperative outcomes of patients undergoing abdominal hysterectomies for leiomyomas before and after the implementation of an enhanced recovery after surgery (ERAS) protocol in a teaching hospital. This prospective cohort study compared a patient group from a historical series (pre-ERAS) with another group after ERAS implementation. Fasting time, length of hospital stay, complications, readmission rates, and procedure-related hospital costs were analyzed. Altogether, 187 patients were included in the analysis: 92 (49.2%) and 95 (50.8%) in the pre-ERAS and ERAS groups, respectively. Both groups had similar clinical characteristics. We observed reductions in surgical outcome findings: fasting time (13.9 to 6.7h, P< 0.001), bladder catheter usage (21.1 to 10.9h, P< 0.001), infection rates (20.7% to 5.3%, P= 0.002), length of stay (57.5 to 37.6h), and 38.4% of the total estimated mean cost per procedure (USD $1570.8 to USD $967.2, P< 0.001) in the pre-ERAS and ERAS groups, respectively. Hospital readmission rates (P> 0.99) did not increase. ERAS protocol implementation for hysterectomies involving uterine leiomyomas reduced the length of hospital stay, surgical site infection rates, and hospital costs. A mean savings of USD $603.6 per procedure would allow 62.4% more hysterectomies to be performed.