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Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Univ Örebro, Dept Obstet & Gynecol, Örebro, Sweden.
Örebro University, School of Medicine, Örebro University, Sweden. Univ Örebro, Dept Obstet & Gynecol, Örebro, Sweden; Univ Örebro, Sch Hlth & Med Sci, Örebro, Sweden.
Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Surg.ORCID iD: 0000-0003-2636-4745
Örebro University, School of Medicine, Örebro University, Sweden. Univ Örebro, Dept Obstet & Gynecol, Örebro, Sweden.
2014 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 8, 749-756 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study the effects of introducing an Enhanced Recovery After Surgery (ERAS) protocol, modified for gynecological surgery, on length of stay and complications following abdominal hysterectomy.

Design: Observational study.

Setting: Department of Obstetrics and Gynecology, Orebro University Hospital, Sweden.

Population: Eighty-five patients undergoing abdominal hysterectomy for benign or malignant indications between January and December 2012, with or without salpingo-oophorectomy. Outcomes were compared with all consecutive patients who had undergone the same surgery from January to December 2011, immediately before establishing the ERAS protocol (n = 120).

Methods: The ERAS protocol was initiated in January 2012 as part of a targeted implementation program. Data were extracted from patient records and from a specific database.

Main outcome measures: Length of stay and the proportion of patients achieving target length of stay (2 days).

Results: Length of stay was significantly reduced in the study population after introducing the ERAS protocol from a mean of 2.6 (SD 1.1) days to a mean of 2.3 (SD 1.2) days (p = 0.011). The proportion of patients discharged at 2 days was significantly increased from 56% pre-ERAS to 73% after ERAS (p = 0.012). No differences were found in complications (5% vs. 3.5% in primary stay, 12% vs. 15% within 30 days after discharge), reoperations (2% vs. 1%) or readmission (4% vs. 4%).

Conclusions: Introducing the ERAS protocol for abdominal hysterectomy reduced length of stay without increasing complications or readmissions.

Place, publisher, year, edition, pages
2014. Vol. 93, no 8, 749-756 p.
Keyword [en]
Fast track, hysterectomy, length of stay, perioperative care, perioperative period
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-36157DOI: 10.1111/aogs.12423ISI: 000339616100004PubMedID: 24828471Scopus ID: 2-s2.0-84904260752OAI: oai:DiVA.org:oru-36157DiVA: diva2:743021
Note

Funding Agency:

Research Committee of Örebro County Council

Available from: 2014-09-03 Created: 2014-08-28 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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Wijk, LenaFranzén, KarinLjungqvist, OlleKerstin, Nilsson

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Acta Obstetricia et Gynecologica Scandinavica
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