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Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease
Örebro University, School of Health Sciences. Department of Obstetrics and Gynecology.
Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
Örebro University, School of Medical Sciences. Department of Surgery.ORCID iD: 0000-0003-2636-4745
Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
2016 (English)In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, 461-467 p.Article in journal (Refereed) Published
Abstract [en]

Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

Place, publisher, year, edition, pages
Basel: S. Karger, 2016. Vol. 81, no 5, 461-467 p.
Keyword [en]
ERAS, Fast-track, Hysterectomy, Length of stay, Perioperative care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-53181DOI: 10.1159/000443396ISI: 000384034700012PubMedID: 26799328Scopus ID: 2-s2.0-84955604181OAI: oai:DiVA.org:oru-53181DiVA: diva2:1039509
Note

Funding Agencies:

Research Committee of Örebro County Council

Nyckelfonden, Örebro, Sweden

Available from: 2016-10-24 Created: 2016-10-24 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Enhanced Recovery After Hysterectomy
Open this publication in new window or tab >>Enhanced Recovery After Hysterectomy
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: To study recovery after hysterectomy under Enhanced Recovery After Surgery (ERAS) care, and in relation to different operation techniques.

Materials and Methods: An observational study was conducted comparing 85 patients undergoing hysterectomy with ERAS care to 120 patients immediately before establishing ERAS. In a prospective cohort study of 121 consecutive patients undergoing hysterectomy, the outcome was compared for patients with malignant versus benign indications. The main outcome measure was length of stay (LOS). A randomised controlled trial (RCT) of 20 women scheduled for hysterectomy compared robot-assisted laparoscopic with abdominal hysterectomy in terms of the development of insulin resistance, inflammatory reactions, and clinical recovery, and examined the relation to hormonal status. All studies were conducted in 2011--2015, at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden.

Results: Implementation of a structured ERAS protocol significantly reduced LOS compared to non-ERAS care. The effect was similar between patients with malignant and benign indications for surgery. No difference in complications was found. There was no difference in development of insulin resistance between robotic and abdominal technique, but clinical outcomes and inflammatory responses significantly favoured robot-assisted hysterectomy. Female sex hormone status was associated with the development of insulin resistance.

Conclusions: Recovery after hysterectomy can be influenced. ERAS care seems to be effective and safe. Clinical outcome can also be influenced by operational technique. Hysterectomy triggers a stress reaction in both the metabolic and the inflammatory system. It remains unclear why the reduced inflammatory reaction and favourable clinical outcome in robotic surgery were not mirrored by less insulin resistance. This could not be explained by female sex hormone status.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 73 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 164
Keyword
Hysterectomy, ERAS, Insulin Resistance, Female Sex hormones
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-58057 (URN)978-91-7529-203-8 (ISBN)
Public defence
2017-09-22, Örebro universitet, Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-06-15 Created: 2017-06-15 Last updated: 2017-10-18Bibliographically approved

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