Thirty-day outcomes after gynecologic oncology surgery: A single-center experience of enhanced recovery after surgery pathways
| Autor: | Jane Su, Waldo Jimenez, Justin M McGinnis, Lorraine Elit, Mohammad Alyafi, Heather Kokus, Clare J. Reade, Delia Palmer, Heidi Thomas, Lua Eiriksson, Laurence Bernard, Limor Helpman, Leonard Potts, Kelly-Lynn Nancekivell |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Genital Neoplasms Female medicine.medical_treatment Population Gynecologic oncology Logistic regression Single Center Patient Readmission Tertiary Care Centers 03 medical and health sciences 0302 clinical medicine Gynecologic Surgical Procedures Postoperative Complications Laparotomy medicine Humans 030212 general & internal medicine Prospective Studies education Ontario education.field_of_study 030219 obstetrics & reproductive medicine business.industry Obstetrics and Gynecology General Medicine Odds ratio Length of Stay Middle Aged Confidence interval Surgery Population study Female business Enhanced Recovery After Surgery |
| Zdroj: | Acta obstetricia et gynecologica ScandinavicaREFERENCES. 100(2) |
| ISSN: | 1600-0412 |
| Popis: | Introduction The purpose of the study is to evaluate the impact of an enhanced recovery after surgery (ERAS) program implemented in a Gynecologic Oncology population undergoing a laparotomy at a Canadian tertiary care center. Material and methods Prospectively collected data, using the American College of Surgeons' National Surgical Quality Improvement Program dataset (ACS NSQIP), was used to compare 30-day postoperative outcomes of gynecologic oncology patients undergoing a laparotomy before and after the 2018 implementation of an ERAS program in a Canadian regional cancer center. Patient demographics, surgical variables and postoperative outcomes of 187 patients undergoing surgery in 2019 were compared with those of 441 patients undergoing surgery between January 2016 and December 2017. Student's t, Mann-Whitney U and Chi-square tests, as well as multivariate linear and logistic regressions were used to evaluate baseline characteristics and 30-day postoperative complications. Results Length of stay was significantly shortened in the study population after introducing the ERAS protocol, from a mean of 4.7 (SD = 3.8) days to a mean of 3.8 (SD = 3.2) days (P = .0001). The overall complication rate decreased from 24.3% to 16% (P = .02). Significant decreases in the rates of postoperative infections (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.31-0.99) and cardiovascular complications (adjusted OR 0.27, 95% CI 0.09-0.79) were noted, without a significant increase in readmission rate (adjusted OR 0.50, 95% CI 0.21-1.07). Conclusions Introducing an ERAS program for gynecologic oncology patients undergoing laparotomy was effective in shortening length of stay and the overall complication rate without a significant increase in readmission. Advocacy for broader implementation of ERAS among gynecologic oncology services and ongoing discussion on challenges and opportunities in the implementation process are warranted to improve patient outcomes and experiences. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|