THE IMPACT OF ERAS ON FPMRS OUTCOMES AT A PUBLIC TEACHING HOSPITAL DURING THE COVID-19 PANDEMIC

ABSTRACT

Introduction: Enhanced recovery after surgery (ERAS) protocols have decreased hospital length of stay (LOS) and increased the rate of same-day discharge in patients undergoing minimally invasive surgery, including in female pelvic medicine and reconstructive surgery (FPMRS). In October of 2019, our hospital implemented an ERAS protocol;however, the onset of the COVID-19 epidemic accelerated the need to adopt a same day discharge policy. Given the rapid implementation of this policy, it was important to determine its effect on FPMRS surgical outcomes in a public teaching hospital serving predominantly uninsured and underinsured patients. Objective: The primary objective of this study was to evaluate perioperative management and postoperative outcomes for FPMRS patients after implementation of an ERAS protocol in a public teaching hospital. Methods: A single-center review was performed of FPMRS patients undergoing surgery prior to introduction of the ERAS protocol from January 2019 to June 2019 compared to those undergoing surgery after its implementation from January 2021 to June 2021. Demographic and surgical details were collected for all patients. A retrospective analysis was performed comparing outcomes, including percentage of outpatient surgery, emergency department visits within 30 days of surgery, and opioid use pre- and post-ERAS implementation Results: 29 patients were included in the pre-implementation group and 19 patients were included in the post-ERAS implementation group. Procedure types and patient demographics are seen in table 1. Ninety-three percent of patients self-described as Hispanic/Latino ethnicity. The percentage of outpatient surgeries increased from 17% to 90% (p < 0.01). Preoperative acetaminophen use increased from 3% to 74% of patients (p < 0.01), while mean perioperative morphine milligram equivalents decreased from 57 mg to 42 mg (p < 0.01). Mean opioid pills prescribed was not different after implementation of ERAS. Thirty-day emergency department (ED) returns increased from 0% to 11% (P = 0.15). These two ED returns included one visit for a urinary tract infection and the other for nephrolithiasis. Conclusions: ERAS implementation for FPMRS patients at a public hospital led to a significant decrease in LOS, inpatient admission, and perioperative morphine milligram equivalents used without a significant increase in 30-day ED returns. While the COVID-19 epidemic resulted in an accelerated adoption of ERAS protocol, it was found to be safe and effective in our underserved FPMRS patient population.