Background: Enhanced recovery after surgery [ERAS] protocols minimise the stress insults of surgery, allowing faster recovery and decreased length of stay [LOS] with an acceptably low complication rate. This approach is useful due to increasing demand for surgery and limited resources.
Aims: To compare LOS and adverse outcomes between ERAS and conventional surgical models of care in gynaecological patients at a single tertiary unit.
Methods: A three-year retrospective study was performed comparing the ERAS and conventional models on all patients undergoing laparoscopic hysterectomy [LH]. The study was powered (80%) to detect a difference of 6 hours in LOS.
Results: Over the study period, 64 patients in the ERAS cohort and 179 patients in the conventional group were analysed. Median age (55 vs 46 (p<0.001)), BMI and country of birth (64% vs 36% born in Australia (p=0.001)) were significantly different between both cohorts. Median LOS in the ERAS cohort was 2 hours shorter than that of the conventional cohort (54 hours vs 56 hours (p=0.009) and was associated with significant decrease in cumulative analgesia use. Country of birth (non-Australian born, p=0.034), age (per year, p=0.006) and malignant histopathology (p=0.004) were all independent risk factors for increased LOS. There was no significant difference in readmission rates or complications between both cohorts.
Conclusion: In this retrospective review, the use of ERAS protocol in gynaecological patients was associated with a minimal decrease in LOS but a significant reduction in postoperative analgesia and no difference in readmission rates or complications. It can be considered a better alternative to conventional surgical practice.