ERAS implementation in an urban patient population undergoing gynecologic surgery

Morgan L Brown; Vidda Simpson; Annabelle B Clark; Margarite D Matossian; Stacey L Holman; Amelia Marie Jernigan; Stacey A Scheib; Jessica Shank; Alison Key; Andrew G Chapple; Elizabeth Kelly; Navya Nair

doi:10.1016/j.bpobgyn.2022.07.009

ERAS implementation in an urban patient population undergoing gynecologic surgery

Best Pract Res Clin Obstet Gynaecol. 2022 Dec;85(Pt B):1-11. doi: 10.1016/j.bpobgyn.2022.07.009. Epub 2022 Aug 7.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, Room 519, New Orleans, LA 70112, USA; Department of Surgery, LSU School o Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address: Mbro41@lsuhsc.edu.
² Department of Obstetrics and Gynecology, Tulane University, 1430 Tulane Ave #4500, New Orleans, LA 70112, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University 14 Medical Center, Augusta, GA 30912, USA. Electronic address: vmoussavi@tulane.edu.
³ Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, Room 519, New Orleans, LA 70112, USA. Electronic address: annabelleclark@aol.com.
⁴ Department of Obstetrics and Gynecology, Tulane University, 1430 Tulane Ave #4500, New Orleans, LA 70112, USA. Electronic address: mmatossi@tulane.edu.
⁵ Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, Room 519, New Orleans, LA 70112, USA. Electronic address: sholma@lsuhsc.edu.
⁶ Department of Obstetrics and Gynecology - Gynecologic Oncology, LSU School of Medicine, 1542, Tulane Avenue, Room 519, New Orleans, LA 70112, USA. Electronic address: ajerni@lsuhsc.edu.
⁷ Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, Room 519, New Orleans, LA 70112, USA. Electronic address: Ssche3@lsuhsc.edu.
⁸ Department of Obstetrics and Gynecology - Gynecologic Oncology, Tulane University, 1430 Tulane Ave #4500, New Orleans, LA 70112, USA. Electronic address: Jshank1@tulane.edu.
⁹ Department of Obstetrics and Gynecology, Tulane University, 1430 Tulane Ave #4500, New Orleans, LA 70112, USA. Electronic address: Akey1@tulane.edu.
¹⁰ LSU School of Public Health, Biostatistics Program, 2020 Gravier St., 3rd Floor, New Orleans, LA 70112, USA. Electronic address: achapp@lsuhsc.edu.
¹¹ Department of Obstetrics and Gynecology, Tulane University, 1430 Tulane Ave #4500, New Orleans, LA 70112, USA. Electronic address: Ekelly2@tulane.edu.
¹² Department of Obstetrics and Gynecology - Gynecologic Oncology, LSU School of Medicine, 1542, Tulane Avenue, Room 519, New Orleans, LA 70112, USA. Electronic address: nnair@lsuhsc.edu.

PMID: 36031533
DOI: 10.1016/j.bpobgyn.2022.07.009

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols improve outcomes. We investigated ERAS implementation in a population with comorbid conditions, inadequate insurance, and barriers to healthcare undergoing gynecologic surgery.

Objective: To investigate ERAS implementation in publicly insured/uninsured patients undergoing gynecologic surgery on hospital length of stay (LOS), 30-day hospital readmission rates, opioid administration, and pain scores.

Study design: Data were obtained pre- and post-ERAS implementation. Patients undergoing gynecologic surgery with private insurance, public insurance, and uninsured were included (N = 589). LOS, readmission <30 days, opioid administration, and pain scores were assessed.

Results: Implementation of ERAS led to shorter LOS 1.75 vs. 1.49 days (p = 0.008). Average pain scores decreased from 3.07 pre-ERAS vs. 2.47 post-ERAS (p = <0.001). Opioid use decreased for ERAS patients (67.22 vs. 33.18, p = <0.001). Hospital readmission rates were unchanged from 8.2% pre-ERAS vs. 10.3% post-ERAS (p = 0.392).

Conclusions: ERAS decreased pain scores and opioid use without increasing LOS or readmissions.

Keywords: Enhanced recovery after surgery (ERAS); Length of stay (LOS); Opioids; Readmission.

Publication types

Review

MeSH terms

Analgesics, Opioid
Enhanced Recovery After Surgery*
Female
Gynecologic Surgical Procedures / methods
Humans
Length of Stay
Pain / etiology
Postoperative Complications / etiology
Retrospective Studies

Substances

Analgesics, Opioid