Thirty-day outcomes after gynecologic oncology surgery: A single-center experience of enhanced recovery after surgery pathways.
Enhanced Recovery After Surgery
Female
Genital Neoplasms, Female
/ surgery
Gynecologic Surgical Procedures
Humans
Length of Stay
/ statistics & numerical data
Middle Aged
Ontario
/ epidemiology
Patient Readmission
/ statistics & numerical data
Postoperative Complications
/ epidemiology
Prospective Studies
Tertiary Care Centers
enhanced recovery after surgery
gynecologic oncology
gynecologic surgical procedures
neoplasms; laparotomy
outcome assessment
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
01
07
2020
revised:
16
08
2020
accepted:
23
09
2020
pubmed:
2
10
2020
medline:
23
2
2021
entrez:
1
10
2020
Statut:
ppublish
Résumé
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. 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. 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). 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
353-361Informations de copyright
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology.
Références
Carli F. Considérations physiologiques sur les programmes de Récupération rapide après la chirurgie (RRAC): implications de la réponse au stress. Can J Anesth. 2015;62:110-119.
Scott MJ, ChB M, Miller TE. Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes. Anesthesiol Clin. 2015;33:79-91.
Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;(2):CD007635.
Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. 2017;152:292-298.
Hu Z-C, He L-J, Chen D, et al. An enhanced recovery after surgery program in orthopedic surgery: a systematic review and meta-analysis. J Orthop Surg Res. 2019;14:77.
Martin LW, Sarosiek BM, Harrison MA, et al. Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg. 2018;105:1597-1604.
Vukovic N, Dinic L. Enhanced recovery after surgery protocols in major urologic surgery. Front Med (Lausanne). 2018;5:93.
Tyson MD, Chang SS. Enhanced recovery pathways versus standard care after cystectomy: a meta-analysis of the effect on perioperative outcomes. Eur Urol. 2016;70:995-1003.
Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery after Surgery (ERAS®) Society recommendations - Part I. Gynecol Oncol. 2016;140:313-322.
Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations - 2019 update. Int J Gynecol Cancer. 2019;29:651-668.
Ore AS, Shear MA, Liu FW, et al. Adoption of enhanced recovery after laparotomy in gynecologic oncology. Int J Gynecol Cancer. 2020;30:122-127.
Lindemann K, Kok PS, Stockler M, Sykes P, Brand A. Enhanced recovery after surgery for suspected ovarian malignancy: a survey of perioperative practice among gynecologic oncologists in Australia and New Zealand to Inform a Clinical Trial. Int J Gynecol Cancer. 2017;27:1046-1050.
Zelal Muallem M, Dimitrova D, Pietzner K, et al. Implementation of Enhanced Recovery After Surgery (ERAS) pathways in gynecologic oncology. A NOGGO-AGO* survey of 144 Gynecological Departments in Germany. Anticancer Res. 2016;36:4227-4232.
Altman AD, Helpman L, McGee J, et al. Enhanced recovery after surgery: Implementing a new standard of surgical care. CMAJ. 2019;191:E469-E475.
Bisch SP, Wells T, Gramlich L, et al. Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: system-wide implementation and audit leads to improved value and patient outcomes. Gynecol Oncol. 2018;151:117-123.
Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Qual Saf. 2014;23:290-298.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018;379:1895-1904.
American College of Surgeons. American College of Surgeons National Surgical Quality Improvement Program "User Guide for the 2014 ACS NSQIP Participant Use Data File (PUF)". 2015. https://www.facs.org/~/media/files/quality%20programs/nsqip/nsqip_puf_userguide_2014.ashx
Heinze G, Dunkler D. Five myths about variable selection. Transpl Int. 2017;30:6-10.
Kalogera E, Bakkum-Gamez JN, Jankowski CJ, et al. Enhanced recovery in gynecologic surgery. Obstet Gynecol. 2013;122(2 Pt 1):319-328.
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149:830-840.
Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis. 2009;24:1119-1131.
Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: AN update of meta-analysis of randomized controlled trials. Int J Colorectal Dis. 2012;27:1549-1554.
Varadhan KK, Neal KR, Dejong CHC, Fearon KCH, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr. 2010;29:434-440.
Walter CJ, Collin J, Dumville JC, Drew PJ, Monson JR. Enhanced recovery in colorectal resections: a systematic review and meta-analysis. Color Dis. 2009;11:344-353.
Wind J, Polle SW, Fung Kon Jin PHP, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93:800-809.
Le ZC, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a metaanalysis of randomized controlled trials. Dis Colon Rectum. 2013;56:667-678.
Chambers D, Paton F, Wilson P, et al. An overview and methodological assessment of systematic reviews and meta-analyses of enhanced recovery programmes in colorectal surgery. BMJ Open. 2014;4:e005014.
Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg. 2014;38:1531-1541.
Boitano TKL, Smith HJ, Rushton T, et al. Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy. Gynecol Oncol. 2018;151:282-286.
Marx C, Rasmussen T, Jakobsen D, et al. Accelerated course after operation for ovarian cancer. Ugeskr Laeger. 2006;168:1533-1536.
Mendivil AA, Busch JR, Richards DC, Vittori H, Goldstein BH. The impact of an Enhanced Recovery After Surgery Program on patients treated for gynecologic cancer in the community hospital setting. Int J Gynecol Cancer. 2018;28:581-585.
Modesitt SC, Sarosiek BM, Trowbridge ER, et al. Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization. Obstet Gynecol. 2016;128:457-466.
Wijk L, Franzen K, Ljungqvist O, Nilsson K. Implementing a structured Enhanced Recovery after Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy. Acta Obstet Gynecol Scand. 2014;93:749-756.
Marx C, Rasmussen T, Hjort Jakobsen D, et al. The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy. Acta Obstet Gynecol Scand. 2006;85:488-492.
Lu D, Wang X, Shi G. Perioperative enhanced recovery programmes for gynaecological cancer patients. Cochrane Database Syst Rev. 2015;(3):CD008239.
Dickson EL, Stockwell E, Geller MA, et al. Enhanced recovery program and length of stay after laparotomy on a gynecologic oncology service: a randomized controlled trial. Obstet Gynecol. 2017;129:355-362.
Bergstrom JE, Scott ME, Alimi Y, et al. Narcotics reduction, quality and safety in gynecologic oncology surgery in the first year of enhanced recovery after surgery protocol implementation. Gynecol Oncol. 2018;149:554-559.
Wijk L, Udumyan R, Pache B, et al. International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery. Am J Obstet Gynecol. 2019;221:237.e1-237.e11.
Pache B, Jurt J, Grass F, et al. Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance? Int J Gynecol Cancer. 2019;29:810-815.
Iniesta MD, Lasala J, Mena G, et al. Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery. Int J Gynecol Cancer. 2019;29:1417-1424.
Pędziwiatr M, Mavrikis J, Witowski J, et al. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery. Med Oncol. 2018;35:95.
Gentry ZL, Boitano TKL, Smith HJ, Eads DK, Russell JF, Straughn JM. The financial impact of an enhanced recovery after surgery (ERAS) protocol in an academic gynecologic oncology practice. Gynecol Oncol. 2020;156:284-287.
Harrison RF, Li Y, Guzman A, et al. Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs. Am J Obstet Gynecol. 2020;222:66.e1-66.e9.
Pache B, Joliat GR, Hübner M, et al. Cost-analysis of Enhanced Recovery After Surgery (ERAS) program in gynecologic surgery. Gynecol Oncol. 2019;154:388-393.