Title : Outcomes comparison for benign gynecologic laparotomy before and after Enhanced Recovery after Surgery (ERAS®) implementation in a Philippine private tertiary hospital
Abstract:
Background: Enhanced Recovery after Surgery (ERAS®), a multidisciplinary approach developed to improve care processes, is utilized by The Medical City, and expanded to include gynecologic cases in 2017. These evidence-based guidelines were disseminated to gynecologists and utilized for patient management. We determined the frequency of compliance to the ERAS Guidelines and the difference in outcomes of benign gynecologic surgeries between pre- and post- ERAS implementation, specifically: length of stay, complications, readmission, re-operation, 30-day morbidity, and mortality rate. This is to further optimize the use of ERAS, improve patient care, and outcome.
Methods: The gynecology interventions published by the ERAS society were followed, with data encoded in the ERAS Interactive Audit System version 4.5.3.3. A retrospective chart review of patients in The Medical City who underwent hysterectomy with or without adnexal surgery, myomectomy, and adnexal surgeries was done and assigned the period of January 2015 to March 2017 as pre-ERAS, and April 2017 to January 2022 as post-ERAS. We excluded patients who were pregnant, pre-operatively admitted in the Intensive Care Unit (ICU) and underwent emergency surgeries in less than 30 minutes. We included in our analysis 739 patients, subdivided according to the three surgical procedures and into pre-ERAS (n=319) and post-ERAS (n=420). Analysis was carried out using an Independent T-test, Mann Whitney U test, and Chi-Square test or Test on Proportions.
Results: Across all three surgical procedures, total length of hospital stays, duration from operation to ready for discharge, and length of stay post-operatively were shorter by one day in the post ERAS period (p<.0001). Pre-operatively, ERAS components (pre-admission education, nutritional status evaluation, oral carbohydrate treatment, and sedative medication prior to anesthesia regardless of route) were accomplished more frequently during post-ERAS period (p<.0001). Post-operatively, post-ERAS patients were more frequently able to tolerate solids in less than 24 hours, had significant earlier time to pass flatus and stool without medication, termination of intravenous fluid infusion on post-operative day one, earlier foley catheter removal within 24 hours, and shorter recovery period prior to return to mobilization (p<.033 to .0001). Pre- and post-ERAS periods were comparable in terms of intraoperative compliance, complication, and readmission. There were no reoperation, morbidity, and mortality for both.
Conclusion: Findings showed improved outcomes with the use of ERAS Guidelines in terms of length of hospital stay and clinical parameters for compliance. Further studies regarding impact of ERAS implementation on cost is recommended.
