The Impact of Enhanced Recovery after Surgery on Outpatient Recovery after Laparoscopic Hysterectomy

Abstract

Study Objective Enhanced Recovery after Surgery (ERAS) pathways have led to improved perioperative outcomes in hospital quality of care and cost parameters in gynecologic surgery. There is less data on the impact of ERAS on patient-reported recovery experience after laparoscopic hysterectomy in the outpatient setting. Design An IRB-approved single-blinded non-randomized prospective cohort study compared two cohorts of patients who underwent laparoscopic hysterectomy: perioperative ERAS protocol or standard perioperative care at a single institution. Surveys were distributed to patients at their initial postoperative appointment. Setting Urban academic-affiliated community tertiary care center. Patients or Participants Women undergoing laparoscopic hysterectomy by high volume surgeons (>10 hysterectomies per year). Interventions Perioperative ERAS protocol; postoperative self-administered survey 2 weeks after surgery. Measurements and Main Results Between 8/1/18 and 4/9/19, 73 patients undergoing laparoscopic hysterectomy were surveyed: 37 (ERAS) cases and 44 under standard perioperative care (controls). 8 surveys from the control group were excluded due to predefined criteria. The patients responded to Likert scaled questions regarding ability to perform daily activities (ascending difficulty from 1 to 5). Conclusion Implementation of ERAS does not adversely affect self-reported patient recovery. At two weeks following laparoscopic hysterectomy, the majority of patients returned to baseline physical activity, bowel function, appetite & diet, and required no additional narcotic medications.