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Multimodal perioperative pain protocol for gynecologic laparotomy is associated with reduced hospital length of stay
Author(s) -
Mattson Jordan,
Thayer MacKenzie,
Mott Sarah L.,
Lyons Yasmin A.,
HardyFairbanks Abbey,
Hill Emily K.
Publication year - 2021
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14640
Subject(s) - medicine , perioperative , laparotomy , regimen , gynecologic oncology , surgery , gabapentin , anesthesia , pathology , alternative medicine
Objectives The primary objective was to evaluate the impact of a multimodal perioperative pain regimen on length of hospital stay for patients undergoing laparotomy with a gynecologic oncologist. Methods We compared 52 patients who underwent laparotomy with a gynecologic oncologist at a single institution between 2017 and 2018, after implementation of a multimodal perioperative pain regimen, to a historic cohort of 94 patients (2016–2017). The multimodal pain regimen included pre‐ and post‐operative administration of oral acetaminophen, gabapentin, and celecoxib, in addition to standard narcotics and optional epidural analgesia. Demographic, surgical, and post‐operative data were collected. Results On multivariable analysis, bowel resection, stage, surgery length, age, and cohort group were retained as significant independent predictors of length of stay. Patients undergoing laparotomy prior to the pain protocol had a length of stay 1.26 times longer than patients during the post‐implementation period ( p < 0.01). For complex surgical patients, this translated into a reduction in length of hospital stay of 1.73 days. There was a significant reduction in pain scale score on post‐operative day zero from 5 to 3 ( p = 0.02) and a non‐significant overall reduction of post‐operative morphine equivalents, with similar adverse outcomes. Conclusion Implementation of a multimodal perioperative pain regimen in patients undergoing gynecologic oncology laparotomy was associated with a significant reduction of length of hospital stay and improved patient‐perceived pain, even in the absence of a complete Enhanced Recovery After Surgery (ERAS) protocol.