Enhanced recovery after surgery for hysterectomy for pelvic organ prolapse
Keywords:
Enhanced recovery after surgery, Length of stay, Pelvic organ prolapseAbstract
Objectives: To investigate whether enhanced recovery after surgery (ERAS) for major urogynaecological surgery could reduce length of stay (LOS) and accelerate recovery, as measured by time to full mobilisation and resumption of oral intake.
Methods: An ERAS programme was implemented in our hospital in March 2022. We retrospectively reviewed medical records of women who underwent vaginal hysterectomy with or without laparoscopic assistance or concomitant procedures (pelvic floor repair, sacrospinous fixation, and continence surgery) performed or supervised by at least one urogynaecology subspecialist between July 2020 and May 2023.
Results: In total, 73 patients who underwent vaginal hysterectomy before (n=32) or after (n=41) ERAS implementation were included. The ERAS group had shorter LOS (3.2 vs 4.9 days, p<0.001) and faster recovery, as measured by
times to full mobilisation (1 vs 1 day, p<0.001), oral intake resumption (0 vs 0 day, p<0.001), and successful urethral catheter removal (1 vs 2 days, p<0.001). In the ERAS group, the mean self-reported pain scores were 0.56 at rest and 2.73 during movement. Seven (17.1%) patients experienced postoperative nausea and vomiting. The predictor of LOS was the time required for successful urethral catheter removal (β=0.052, p<0.001). One patient in each group was readmitted to hospital within 30 days for vaginal bleeding. Two patients without ERAS developed vault infection, which resolved with antibiotic treatment.
Conclusion: The ERAS programme can shorten LOS among patients undergoing vaginal hysterectomy. The duration of urethral catheter use was the main predictor of LOS.
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