Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy
| Autor: | Charles A. Leath, Prentiss Lawson, Meredith P. Guthrie, J. Michael Straughn, Haller J. Smith, Teresa K.L. Boitano, Anisa Xhaja, Tullia Rushton, Mary C. Johnston |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Ileus Nausea Genital Neoplasms Female medicine.medical_treatment Gynecologic oncology Perioperative Care Cohort Studies 03 medical and health sciences 0302 clinical medicine Gynecologic Surgical Procedures Postoperative Complications Laparotomy medicine Humans Retrospective Studies 030219 obstetrics & reproductive medicine business.industry Obstetrics and Gynecology Retrospective cohort study Middle Aged medicine.disease Surgery Oncology 030220 oncology & carcinogenesis Cohort Vomiting Female medicine.symptom Gastrointestinal function business |
| Zdroj: | Gynecologic oncology. 151(2) |
| ISSN: | 1095-6859 |
| Popis: | To evaluate the impact of enhanced recovery after surgery (ERAS) on postoperative gastrointestinal function in gynecologic oncology patients.This retrospective cohort study compared gynecology oncology patients undergoing non-emergent laparotomy from 10/2016 to 6/2017 managed on an ERAS protocol to a control cohort from the year prior to ERAS implementation. Major changes to postoperative care after ERAS implementation included multimodal analgesia, early feeding, goal-directed fluid resuscitation, and early ambulation. The primary outcome was rate of postoperative ileus, defined as nausea and vomiting requiring nothing-per-mouth status or nasogastric tube (NGT) placement. Secondary outcomes included length of stay (LOS) and 30-day readmission.376 patients met inclusion criteria; 197 in the control group and 179 in the ERAS group. Patient demographics were similar between groups. Ileus rate was significantly lower in the ERAS group (2.8% vs. 15.7%; p 0.001), and fewer patients in the ERAS group required NGT placement (2.2% vs. 7.1%; p = 0.06). ERAS remained independently associated with decreased ileus rates when controlling for other patient and surgical factors (OR 0.2; p = 0.01). Epidural use was correlated with a significant increase in ileus risk (OR 2.6; p = 0.03), as was increased Charlson Comorbidity Index (OR 1.2; p 0.01). LOS was significantly decreased in the ERAS group (2.9 vs. 4.0 days; p = 0.04), while 30-day readmission rates were similar (10.1% vs. 10.7%; p = 0.62).Implementation of an ERAS protocol significantly decreases the risk of postoperative ileus in gynecologic oncology patients undergoing laparotomy. ERAS also reduced LOS compared to pre-ERAS controls. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect