OBJECTIVE: To investigate the effect of an enhanced recovery after surgery (ERAS) program on perioperative outcomes with an emphasis on opioid consumption and patient-reported outcomes in the immediate and extended postoperative periods. METHODS: We initiated our ERAS program as part of a quality improvement initiative in November 2014. We compared clinical outcomes among a cohort of 607 women undergoing open gynecologic surgery before or after implementation of ERAS. For 293 patients, patient-reported outcomes were compared using the MD Anderson Symptom Inventory-Ovarian Cancer. RESULTS: Median age was 58 years (range 18-85 years). Median length of stay decreased by 25% for patients in the ERAS pathway (P<.001). Overall, patients in the ERAS group had a 72% reduction in median opioid consumption and 16% were opioid-free during admission up to postoperative day 3 (P<.001). There was no difference in pain scores (P=.80). Patients on ERAS reported less fatigue (P=.01), interference with walking (P=.003), and total interference (composite score of physical and affective measures) during hospitalization (P=.008). After discharge, those on the ERAS pathway demonstrated a significantly shorter median time to return to no or mild fatigue (10 vs 30 days, P=.03), mild or no interference with walking (5 vs 13 days, P=.003), and mild to no total interference (3 vs 13 days, P=.02). There were no significant differences in complications, rates of readmission, or reoperation between the pre- and post-ERAS groups. CONCLUSION: Implementation of an ERAS program was associated with significantly decreased opioid use after surgery and improvement in key patient-reported outcomes associated with functional recovery after surgery without compromising pain scores.
OBJECTIVE: To investigate the effect of an enhanced recovery after surgery (ERAS) program on perioperative outcomes with an emphasis on opioid consumption and patient-reported outcomes in the immediate and extended postoperative periods. METHODS: We initiated our ERAS program as part of a quality improvement initiative in November 2014. We compared clinical outcomes among a cohort of 607 women undergoing open gynecologic surgery before or after implementation of ERAS. For 293 patients, patient-reported outcomes were compared using the MD Anderson Symptom Inventory-Ovarian Cancer. RESULTS: Median age was 58 years (range 18-85 years). Median length of stay decreased by 25% for patients in the ERAS pathway (P<.001). Overall, patients in the ERAS group had a 72% reduction in median opioid consumption and 16% were opioid-free during admission up to postoperative day 3 (P<.001). There was no difference in pain scores (P=.80). Patients on ERAS reported less fatigue (P=.01), interference with walking (P=.003), and total interference (composite score of physical and affective measures) during hospitalization (P=.008). After discharge, those on the ERAS pathway demonstrated a significantly shorter median time to return to no or mild fatigue (10 vs 30 days, P=.03), mild or no interference with walking (5 vs 13 days, P=.003), and mild to no total interference (3 vs 13 days, P=.02). There were no significant differences in complications, rates of readmission, or reoperation between the pre- and post-ERAS groups. CONCLUSION: Implementation of an ERAS program was associated with significantly decreased opioid use after surgery and improvement in key patient-reported outcomes associated with functional recovery after surgery without compromising pain scores.
Authors: Cornelius A Thiels; Stephanie S Anderson; Daniel S Ubl; Kristine T Hanson; Whitney J Bergquist; Richard J Gray; Halena M Gazelka; Robert R Cima; Elizabeth B Habermann Journal: Ann Surg Date: 2017-10 Impact factor: 12.969
Authors: Mary H Sailors; Diane C Bodurka; Ibrahima Gning; Lois M Ramondetta; Loretta A Williams; Tito R Mendoza; Sonika Agarwal; Charlotte C Sun; Charles S Cleeland Journal: Gynecol Oncol Date: 2013-05-15 Impact factor: 5.482
Authors: Roger Chou; Debra B Gordon; Oscar A de Leon-Casasola; Jack M Rosenberg; Stephen Bickler; Tim Brennan; Todd Carter; Carla L Cassidy; Eva Hall Chittenden; Ernest Degenhardt; Scott Griffith; Renee Manworren; Bill McCarberg; Robert Montgomery; Jamie Murphy; Melissa F Perkal; Santhanam Suresh; Kathleen Sluka; Scott Strassels; Richard Thirlby; Eugene Viscusi; Gary A Walco; Lisa Warner; Steven J Weisman; Christopher L Wu Journal: J Pain Date: 2016-02 Impact factor: 5.820
Authors: G Nelson; A D Altman; A Nick; L A Meyer; P T Ramirez; C Achtari; J Antrobus; J Huang; M Scott; L Wijk; N Acheson; O Ljungqvist; S C Dowdy Journal: Gynecol Oncol Date: 2016-01-03 Impact factor: 5.482
Authors: Catherine N Vu; Carol M Lewis; Neil S Bailard; Ravish Kapoor; M Laura Rubin; Gang Zheng Journal: JAMA Otolaryngol Head Neck Surg Date: 2020-06-18 Impact factor: 6.223
Authors: Rebecca K Marcus; Heather A Lillemoe; David C Rice; Gabriel Mena; Brian K Bednarski; Barbra B Speer; Pedro T Ramirez; Javier D Lasala; Neema Navai; Wendell H Williams; Bradford J Kim; Rachel K Voss; Vijaya N Gottumukkala; Thomas A Aloia Journal: Ann Surg Oncol Date: 2019-01-09 Impact factor: 5.344
Authors: R Tyler Hillman; Amalia Sanchez-Migallon; Larissa A Meyer; Maria D Iniesta; Katherine E Cain; Ashley M Siverand; Simone P L Veum; Tina S Suki; Javier D Lasala; Pedro T Ramirez Journal: Gynecol Oncol Date: 2019-03-20 Impact factor: 5.482
Authors: Ross F Harrison; Yao Li; Alexis Guzman; Brandelyn Pitcher; Andrea Rodriguez-Restrepo; Katherine E Cain; Maria D Iniesta; Javier D Lasala; Pedro T Ramirez; Larissa A Meyer Journal: Am J Obstet Gynecol Date: 2019-07-31 Impact factor: 8.661
Authors: Elisa Rodriguez Trowbridge; Sarah L Evans; Bethany M Sarosiek; Susan C Modesitt; Dana L Redick; Mohamed Tiouririne; Robert H Thiele; Traci L Hedrick; Kathie L Hullfish Journal: Int Urogynecol J Date: 2018-10-29 Impact factor: 2.894
Authors: Ross Harrison; Maria D Iniesta; Brandelyn Pitcher; Pedro T Ramirez; Katherine Cain; Ashley M Siverand; Gabriel Mena; Javier Lasala; Larissa A Meyer Journal: Int J Gynecol Cancer Date: 2020-08-26 Impact factor: 3.437
Authors: R Tyler Hillman; Maria D Iniesta; Qiuling Shi; Tina Suki; Tsun Chen; Katherine Cain; Loretta Williams; Xin Shelley Wang; Jolyn S Taylor; Gabriel Mena; Javier Lasala; Pedro T Ramirez; Larissa A Meyer Journal: Int J Gynecol Cancer Date: 2020-11-06 Impact factor: 3.437