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Safety and economics of an enhanced recovery after surgery protocol in pelvic reconstructive surgery.
Dutta, Rahul; Xu, Raymond; Cui, Tao; Bubnov, Andre S; Matthews, Catherine Ann.
  • Dutta R; Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  • Xu R; Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  • Cui T; Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  • Bubnov AS; Financial Planning, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  • Matthews CA; Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA. camatthe@wakehealth.edu.
Int Urogynecol J ; 33(7): 1875-1880, 2022 07.
Article in English | MEDLINE | ID: covidwho-1653425
ABSTRACT
INTRODUCTION AND

HYPOTHESIS:

We hypothesized that an enhanced recovery after surgery (ERAS) protocol for patients undergoing female pelvic reconstructive surgery would conserve hospital resources without compromising patient safety.

METHODS:

In June 2020, an ERAS protocol designed to promote same-day discharge was initiated that included pre-operative hydration, a urinary anesthetic, non-narcotic analgesia, perineal ice, a bowel regimen, enrollment of the family to assist with care, and communication regarding planned same-day discharge. We compared demographic, operative, hospital stay, complications, and cost data in patients undergoing pelvic organ prolapse or incontinence surgery over 4 sequential months pre (PRE; N = 82) and post (POST; N = 91) ERAS implementation using univariate statistics.

RESULTS:

There were no differences in demographics, operative details, or complications (p > 0.05). There were no significant differences in overall revenues or expenses (p > 0.05), but bed unit cost was significantly lower in the POST group ($210 vs $533, p < 0.0001). There was a trend toward an increased operating margin in POST patients ($4,554 vs $2,151, p = 0.1163). Significantly more POST surgeries were performed in an ambulatory setting (73.6% vs 48.8%, p = 0.0008) and resulted in same-day discharge (80.2% vs 50.0%, p = 0.0003). There were no differences in the rates of emergency room or unexpected clinic visits (p > 0.05). Prescribed post-operative opiate dose was significantly reduced in POST patients (p < 0.0001).

CONCLUSIONS:

In patients undergoing female pelvic reconstructive surgery, an ERAS protocol facilitated transfer of procedures to an ambulatory surgical site and permitted same-day discharge without increasing complications, clinic visits, or emergency room visits. It also reduced bed unit cost and may improve operating margins.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Plastic Surgery Procedures / Pelvic Organ Prolapse / Enhanced Recovery After Surgery Type of study: Experimental Studies / Observational study Limits: Female / Humans Language: English Journal: Int Urogynecol J Journal subject: Gynecology / Urology Year: 2022 Document Type: Article Affiliation country: S00192-021-05054-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Plastic Surgery Procedures / Pelvic Organ Prolapse / Enhanced Recovery After Surgery Type of study: Experimental Studies / Observational study Limits: Female / Humans Language: English Journal: Int Urogynecol J Journal subject: Gynecology / Urology Year: 2022 Document Type: Article Affiliation country: S00192-021-05054-9