Patients who had complex gynecologic surgery managed by an enhanced recovery pathway (ERP) resulted in decreased narcotic use, earlier discharge, stable readmission rates, excellent patient satisfaction and cost savings, according to a Mayo Clinic study. The findings are published in the journal Obstetrics & Gynecology.
A team of gynecologic oncologists, urogynecologists and anesthesiologists developed an enhanced recovery pathway for patients undergoing gynecologic surgery to recover more quickly. Prior to the ERP for gynecologic surgery, patients had extensive bowel preparations, caloric restriction, received more intravenous fluids, bed rest, high rates of intravenous opioid use, and drains and catheters were used liberally. The ERP standardized postoperative management to avoid prolonged preoperative fasting and eliminated bowel cleansing. Patients are eating, drinking and ambulating shortly after surgery. In addition, drains and nasogastric tubes are not routinely used and urinary catheters are promptly removed after 24 hours. Patients receive limited IV narcotics and their fluid is restricted to avoid fluid overload.
"Patients are much happier when we are able to eliminate the use of unproven and unpleasant interventions such as bowel preparations, caloric restriction, sedating medications and the use of surgical drains," says Sean Dowdy, M.D., a Mayo Clinic gynecologic surgeon and lead study author. "We show that patients undergoing the most complex and invasive operations have the most to gain from this recovery pathway."
In a retrospective study, the researchers studied the outcomes of 241 women who followed the ERP during a six-month period and compared them to 235 women who did not follow the ERP during a nine-month period. The patients were divided into three cohorts: patients with complicated vaginal surgeries due to pelvic floor dysfunction; surgery through the abdomen for hysterectomy and lymph node dissection for ovarian or endometrial cancer; and extensive, complex surgeries for patients with ovarian cancer.