Implementation Of Enhanced Recovery After Surgery In Gynecologic Surgery

Objective: Enhanced Recovery After Surgery(ERAS)is an evidence-based surgical quality improvement initiative,which has been shown to promote patient mobilization,reduce complication rates after surgery,decrease length of hospital stay and reduce costs.The purpose of this study is to examine the effect of ERAS protocol in women undergoing laparoscopic gynecologic surgery and prove that the approach can safely and effectively improve patients’ outcomes.Methods: The study included 240 participants of laparoscopic ovarian cystectomy surgery,171 cases of laparoscopic hysterectomy(+/-adnexal surgery)and 90 cases of endometrial cancer(EC)who received laparoscopic surgery in our center from December 2019 to December 2021.They were randomly divided into ERAS group receiving ERAS protocol and control group.Preoperative clinical data,surgical parameters and outcomes of patients were recorded.We compared the situation of duration of surgery,intraoperative blood loss,hospital length of stay,first postoperative exhaust time,postoperative pain response and complications between two groups.Analyses were performed using SPSS 26.0.Results:1.The study included 240 patients undergoing laparoscopic ovarian cystectomy.120 patients were enrolled in ERAS protocol group and 120 women,respectively,in the control group.There were no significant differences in age,gravidity,BMI,operation time and intraoperative blood loss between the two groups(p>0.05).Compared with the control group,first postoperative exhaust time was significantly shorter in ERAS group(13.57±3.79 h vs.17.79±3.65 h,p<0.001).ERAS patients were ambulated early,and the difference was highly significant(10.53±0.55 h vs.10.67±0.43 h,p<0.001).we confirmed a statistically significant shortening of the LOS for the women enrolled in the ERAS protocol group(p<0.001).The ERAS group had lower score of VAS during the 6th hour,12 th hour and 24 th hour(1.59±0.51 vs.2.77±0.66 p<0.05;2.32±0.90 vs.3.46±1.27p<0.05;1.28±0.63 vs.1.49±0.49 p<0.05).The Although ERAS protocol group was not associated with a persistent statistically significant reduction of abdominal distension(p=0.389),fever(p=0.329),and deep venous thrombosis(p>0.05)between two groups,ERAS group had lower the incidence of postoperative complications(p=0.040).2.A total of 171 patients undergoing laparoscopic hysterectomy(+/-adnexal surgery),they were divided into ERAS group(n=84)and control group(n=87).There were no significant differences in age(p=0.214),gravidity(p=0.838),BMI(p=0.072)and abdominal surgery history(p=0.412)between two groups.The operation time(p=0.773)and intraoperative blood loss(p=0.133)of the ERAS group showed no significant difference compared the control group.Time to first flatus was significantly lower in the ERAS group compared(18.56±3.62 h vs.20.23±4.48 h,p=0.008).ERAS patients were ambulated early,and the difference was highly significant(12.33±3.81 h vs.16.70±2.77 h,p<0.001).The length of hospital stay was significantly lower in the ERAS group compared to the control group(4.33±0.77 d vs.4.63±0.75 d,p=0.011).The ERAS group had lower score of VAS(p<0.05).And ERAS group had lower the incidence of postoperative complications(p<0.05).3.In total,of 90 EC patients with pathological diagnosis of stage I,45 were allocated in the ERAS group,and the remaining 45 were included in the control pathway group.All patients underwent hysterectomy and lymph node dissection(pelvic and para-aortic lymphadenectomy).There was no significant differences in the baseline characteristics between the two groups.The operation time of the control group was 176.38±45.41 min,and there was no difference from that the ERAS group 162.3±49.87min(p=0.165).The intraoperative blood loss of the ERAS group showed no significant difference compared the control group(p=0.597).In the control group,42.2%(19/45)patients had different degrees of postoperative complications,while in ERAS group,the incidence of complications was only 22.2%(10/45)with significant difference between the two groups(p=0.042).Clavien-Dindo classification: the incidence of grade I,II,III and IV perioperative complications in 2 groups was 17.8%(8/45)vs.22.2%(10/45),2.2%(1/45)vs.11.1%(5/45),2.2%(1/45)vs.6.6%(3/45)and 0 vs.2.2%(1/45).The severity of complications(II-IV)in the ERAS group was lower,and the difference was statistically significant [4.4%(2/45)vs.20.0%(9/45)p=0.030]Conclusion:1.Enhanced recovery after surgery implementation can significantly promote the recovery of gastrointestinal function,decrease the length of hospital stay and improve peri-operative outcomes in women undergoing laparoscopic gynecologic procedures.2.The application of ERAS protocol had significant benefits over conventional perioperative management.It was associated with a significant reduction in incidence and severity of postoperative complications in women undergoing laparoscopic gynecologic procedures.