Enhanced recovery pathway effective for complex gynecologic surgery

Enhanced recovery pathway (ERP) leads to earlier discharge, cost savings, better patient satisfaction, lower narcotic use, and more stable readmission rates in complex gynecologic surgery patients, according to a study recently published in Obstetrics & Gynecology.

Researchers at the Mayo Clinic looked at 241 patients who were managed with an ERP after undergoing cytoreduction (n = 81), surgical staging (n = 84), or pelvic organ prolapse surgery (n = 76) between June 2011 to December 2011 and compared their outcomes with historical control data from March 2010 to December 2010. Direct medical costs in the first 30 days were standardized to 2011 Medicare dollars.

The most dramatic improvements were seen in the cytoreproductive group. Patient-controlled anesthesia decreased from 98.7% to 33.3% and overall opioid use decrease by 80% in the first 48 hours in ERP patients with no change in pain scores. ERP reduced hospital stays by 4 days in 25.9% of women, compared with 17.9% of women in the control group. Cost savings totaled more than $7,600 per ERP patient. No statistically significant differences were seen in the rate or severity of postoperative complications. The improvements were similar in surgical staging and pelvic organ prolapse patients, albeit less dramatic. Perioperative care received a satisfaction rating of excellent or very good from 95% of the patients.

The study’s authors concluded that ERP improves the quality of care for patients undergoing complex gynecologic surgery. They also concluded that the quicker recovery facilitated by ERP can enable patients to undergo other therapies required for their condition.

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