Enhanced Recovery Pathway for Minimally Invasive Hysterectomy: Outcomes of a Quality Improvement Initiative [15Q]

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Abstract

INTRODUCTION:

Enhanced recovery after surgery (ERAS) pathways have decreased postoperative pain and shortened hospital stays. This quality improvement project at a tertiary care academic medical center sought to implement an ERAS pathway for patients undergoing minimally invasive hysterectomy (MIH) for benign indications and evaluate perioperative outcomes.

METHODS:

Consecutive patients managed under an ERAS protocol (implemented June 1, 2016) undergoing MIH for benign indications from August 1-October 31, 2016 were compared to consecutive historical controls (August-October 2015). Demographic, operative, and clinical information was abstracted. Descriptive statistics and bivariate analyses were performed.

RESULTS:

There were 41 procedures performed by 15 surgeons pre-ERAS intervention and 47 performed by 18 surgeons post-ERAS implementation. There was no statistical difference between the groups by age, race, insurance status, ASA class, or BMI. After ERAS implementation, the percentage of patients discharged by noon increased (14.6 to 36.2%, P= .022) with a significant difference in length of stay (P=.029). The use of patient controlled analgesia (PCA) decreased from 51.2 to 10.6% (P<.001). Postoperative narcotic use decreased significantly with a reduction in intravenous oral morphine equivalents (OME) from a median of 5mg (SD 0-25mg) to 0mg (SD 0-4 mg) [P<.001] and in median total OME from 45mg (SD 25-128.5mg) to 24mg (SD 5-48mg) [P<.001]. There was no significant change in postoperative complications or readmissions.

CONCLUSION:

An ERAS pathway quality improvement initiative for benign MIH can be effectively implemented at a large academic center. Our quality improvement program resulted in improved postoperative recovery outcomes and a significant reduction in post-operative narcotic usage.

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