Review of enhanced recovery programs in benign gynecologic surgery

Elisa R Trowbridge; Caitlin N Dreisbach; Bethany M Sarosiek; Catherine Page Dunbar; Sarah Larkin Evans; Lee Anne Hahn; Kathie L Hullfish

doi:10.1007/s00192-017-3442-0

Review of enhanced recovery programs in benign gynecologic surgery

Int Urogynecol J. 2018 Jan;29(1):3-11. doi: 10.1007/s00192-017-3442-0. Epub 2017 Sep 4.

Authors

Elisa R Trowbridge¹, Caitlin N Dreisbach², Bethany M Sarosiek², Catherine Page Dunbar², Sarah Larkin Evans², Lee Anne Hahn², Kathie L Hullfish³

Affiliations

¹ Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Virginia Health System, PO Box 801305, Charlottesville, VA, 22908, USA. etrowbridge@virginia.edu.
² University of Virginia Health System, Charlottesville, VA, USA.
³ Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Virginia Health System, PO Box 801305, Charlottesville, VA, 22908, USA.

PMID: 28871417
DOI: 10.1007/s00192-017-3442-0

Abstract

Introduction and hypothesis: Enhanced recovery programs (ERPs) are evidence-based protocols designed to improve functional rehabilitation after surgery. ERPs have gained widespread acceptance in many surgical disciplines, and their use leads to significant improvements in patient outcomes while reducing hospital length of stay (LOS). There remains a paucity of data on the use of ERPs in benign gynecologic surgery. The purpose of this review was to evaluate current literature on the use of ERP concepts in benign gynecologic surgery.

Methods: A systematic search of PubMed, CINAHL, Web of Science, and the Cochrane databases was conducted, cross-referencing search terms related to gynecologic surgery and ERP concepts. The search was limited to publications available in English. Studies published prior to 2000, and those involving gynecologic oncology, nonadult patients, and outpatient surgery were excluded.

Results: Nine studies were included in the analysis. Due to heterogeneity of the included studies, no statistical pooling was possible and comparison between studies was limited to their respective themes. Primary study outcomes included LOS, postoperative nausea and vomiting (PONV), pain management, patient satisfaction, and hospital costs. Five studies investigated ERPs, two evaluated measures to improve PONV, and four focused on unique aspects of pain management. Across the studies, ERPs that focused on the patients' basic symptoms and recovery were found to have equal, if not better, outcomes than standard practice.

Conclusions: This integrative review supports the implementation of ERPs in benign gynecologic surgery. The results showed that the use of ERPs decreased LOS, improved pain scores, and reduced hospital costs, without increasing perioperative complications. We suggest additional randomized controlled trials of ERP concepts in benign gynecologic surgery to support their more widespread use and application.

Keywords: Benign gynecology; Enhanced recovery after surgery; Enhanced recovery programs; Fast track surgery.

Publication types

Review

MeSH terms

Case-Control Studies
Female
Gynecologic Surgical Procedures / rehabilitation*
Hospital Costs / statistics & numerical data
Humans
Length of Stay / statistics & numerical data
Outcome Assessment, Health Care / methods*
Pain, Postoperative / drug therapy
Patient Satisfaction*
Postoperative Nausea and Vomiting / drug therapy
Postoperative Period
Prospective Studies
Randomized Controlled Trials as Topic
Retrospective Studies