Enhanced recovery after surgery outcomes in minimally invasive nonhysterectomy gynecologic procedures

Am J Obstet Gynecol. 2020 Aug;223(2):234.e1-234.e8. doi: 10.1016/j.ajog.2020.02.008. Epub 2020 Feb 20.


Background: Improved patient outcomes and satisfaction associated with enhanced recovery after surgery protocols have increasingly replaced traditional perioperative anesthesia care. Fast-track surgery pathways have been extensively validated in patients undergoing hysterectomies, yet the impact on fertility-sparing laparoscopic gynecologic operations, particularly those addressing chronic pain conditions, has not been examined.

Objective: The objective of the study was to determine the effects of enhanced recovery after surgery pathway implementation compared with conventional perioperative care in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures.

Study design: We conducted a retrospective cohort study of women undergoing uterine-sparing laparoscopic gynecologic procedures for benign conditions (tubal/adnexal pathology, endometriosis, or leiomyomas) during a 24 month period before and after enhanced recovery after surgery implementation at a tertiary care center. We compared immediate perioperative outcomes and 30 day complications. The primary outcome was same-day discharge rates. Factors influencing unplanned admissions, postoperative pain, sedation, nausea, and vomiting represented secondary analyses.

Results: A total of 410 women (enhanced recovery after surgery, n = 196; conventional perioperative care, n = 214) met inclusion criteria. Following enhanced recovery after surgery implementation, same-day discharge rates increased by 9.4% (P = .001). Reductions in postoperative pain and nausea/vomiting represented the primary driving factor behind lower unplanned admissions. Higher preoperative antiemetic medication administration in the enhanced recovery after surgery group resulted in a 57% reduction in postanesthesia care unit antiemetics (P < .001). Total perioperative narcotic medication use was also significantly reduced by 64% (P < .001), and the enhanced recovery after surgery cohort still demonstrated significantly lower postanesthesia unit care pain scores at hours 2 and 3 (P < .001). A 19 minute shorter postanesthesia care unit stay was noted in the enhanced recovery after surgery cohort (P = .036). Increased same-day discharge did not lead to higher postoperative complications or changes in 30 day emergency department visits or readmissions in patients with enhanced recovery after surgery.

Conclusion: Enhanced recovery after surgery implementation resulted in increased same-day discharge rates and improved perioperative outcomes without affecting 30 day morbidity in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures.

Keywords: chronic pelvic pain; endometriosis; enhanced recovery after surgery; minimally invasive gynecologic surgery; same-day discharge.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anesthesia Recovery Period
  • Denervation / methods
  • Endometriosis / surgery
  • Enhanced Recovery After Surgery*
  • Female
  • Genital Diseases, Female / surgery*
  • Gynecologic Surgical Procedures / methods*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infertility, Female / surgery
  • Laparoscopy / methods*
  • Leiomyoma / surgery
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Ovarian Cysts / surgery
  • Pain, Postoperative / epidemiology
  • Patient Discharge / statistics & numerical data*
  • Pelvic Pain / surgery*
  • Postoperative Nausea and Vomiting / epidemiology
  • Prophylactic Surgical Procedures / methods
  • Retrospective Studies
  • Salpingo-oophorectomy
  • Sterilization, Reproductive / methods
  • Uterine Myomectomy / methods
  • Uterine Neoplasms / surgery
  • Young Adult