Journal Article

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting

Busch, Justin R., Goldstein, Bram H., Vittori, Heather, Richards, David C., Mendivil, Alberto A.

2018

Overview

OBJECTIVESThe purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion. METHODSWe retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates. RESULTSThere were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282). CONCLUSIONSThe results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.

• Publisher: by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology,Elsevier Limited
• Subject: Cytoreduction Surgical Procedures - methods / Cytoreduction Surgical Procedures - standards / Female / Genital Neoplasms, Female - surgery / Gynecologic Surgical Procedures - methods / Gynecologic Surgical Procedures - standards / Hospital costs / Hospitals, Community - organization & administration / Hospitals, Community - standards / Humans / Hysterectomy - methods / Length of stay / Middle Aged / Patients / Perioperative Care - methods / Perioperative Care - standards / Postoperative Care - methods / Postoperative Care - standards / Recovery (Medical) / Retrospective Studies / Salpingo-oophorectomy - methods / Surgery