Open AccessThirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways
Author(s) -
Bernard Laurence,
McGinnis Justin M.,
Su Jane,
Alyafi Mohammad,
Palmer Delia,
Potts Leonard,
Nancekivell KellyLynn,
Thomas Heidi,
Kokus Heather,
Eiriksson Lua R.,
Elit Lorraine M.,
Jimenez Waldo G. F.,
Reade Clare J.,
Helpman Limor
Publication year - 2021
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.14009
Subject(s) - medicine , gynecologic oncology , laparotomy , odds ratio , confidence interval , logistic regression , population , surgery , general surgery , environmental health
The purpose of the study is to evaluate the impact of an enhanced recovery after surgery (ERAS) program implemented in a Gynecologic Oncology population undergoing a laparotomy at a Canadian tertiary care center. Material and methods Prospectively collected data, using the American College of Surgeons’ National Surgical Quality Improvement Program dataset (ACS NSQIP), was used to compare 30‐day postoperative outcomes of gynecologic oncology patients undergoing a laparotomy before and after the 2018 implementation of an ERAS program in a Canadian regional cancer center. Patient demographics, surgical variables and postoperative outcomes of 187 patients undergoing surgery in 2019 were compared with those of 441 patients undergoing surgery between January 2016 and December 2017. Student’s t , Mann‐Whitney U and Chi‐square tests, as well as multivariate linear and logistic regressions were used to evaluate baseline characteristics and 30‐day postoperative complications. Results Length of stay was significantly shortened in the study population after introducing the ERAS protocol, from a mean of 4.7 (SD = 3.8) days to a mean of 3.8 (SD = 3.2) days ( P = .0001). The overall complication rate decreased from 24.3% to 16% ( P = .02). Significant decreases in the rates of postoperative infections (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.31‐0.99) and cardiovascular complications (adjusted OR 0.27, 95% CI 0.09‐0.79) were noted, without a significant increase in readmission rate (adjusted OR 0.50, 95% CI 0.21‐1.07). Conclusions Introducing an ERAS program for gynecologic oncology patients undergoing laparotomy was effective in shortening length of stay and the overall complication rate without a significant increase in readmission. Advocacy for broader implementation of ERAS among gynecologic oncology services and ongoing discussion on challenges and opportunities in the implementation process are warranted to improve patient outcomes and experiences.