Implementation of an enhanced recovery after surgery program in the treatment of uterine fibroids with focused ultrasound ablation surgery

Figures & data

Figure 1. Key steps for the enhanced recovery after surgery (ERAS) protocol for focused ultrasound ablation surgery (FUAS) for the treatment of uterine fibroids.

Figure 2. Simplified study patients’ selection process by phase.

Table 1. Baseline characteristics of patients.

Characteristic	ERAS treatment of uterine fibroids with FUAS
	Pre (n = 224)	Interim (n = 179)	Post (n = 224)	Value (pre and interim)	p-value (interm and post)	p-value (pre and post)
Diagnosis	N = 224	N = 179	N = 224	0.259	.719	.417
Single	67 (29.91%)	63 (35.20%)	75 (33.48%)
Multiple	157 (70.09%)	116 (64.80%)	149 (66.52%)
Age (y)	43.00 (10.75)	41.00 (9.25)	42.0 (10.0)	0.152	.993	.111
Preoperative BMI (kg/m^2)	22.32 (3.49)	22.57 (3.58)	21.87 (3.88)	0.687	.145	.356
Maximum diameter	63.39 ± 24.40	57.31 ± 17.29	61.51 ± 24.31	0.006	.463	.072
Location	N = 208	N = 170	N = 200	0.107	.344	.339
Anterior wall	88 (42.31%)	60 (35.29%)	83 (41.50%)
Posterior wall	65 (31.25%)	49 (28.82%)	62 (31.00%)
Lateral wall	41 (19.71%)	38 (22.35%)	32 (16.00%)
Cervix	14 (6.73%)	23 (13.53%)	23 (11.50%)
Preoperative anemia	N = 219	N = 177	N = 215	0.120	.367	.491
Yes
No	74 (33.79%)	47 (26.55%)	66 (30.70%)
	145 (66.21%)	130 (37.45%)	149 (69.30%)

ERAS: enhanced recovery after surgery; BMI: body mass index.

Data are mean (SD) or n (%) unless otherwise specified.

Table 2. Main outcome measures.

Characteristic	ERAS treatment of uterine fibroids with FUAS
	Pre (n = 222)	Interim (n = 176)	Post (n = 204)	P-Value (pre and interim)	P-value (interim and post)	P-value (pre and post)
Treatment costs (¥)	23694.35 (3358.32)	23240.34 (2908.21)	22612.51 (3189.23)	.216	.019	.000
Total length of hospital stay (day)	3.00 (1.00)	2.00 (2.00)	2.00 (1.00)	.000	.660	.000
Postoperative length of hospital stay (day)	1.00 (0–4)	1.00 (0–2)	1.00 (0–3)	.041	.323	.003

Data are mean (SD) or n (%) unless otherwise specified.

Table 3. Clinical outcomes before, during, and after ERAS.

Outcome	Pre-ERAS	Interim-ERAS	Post-ERAS	p‐value (pre and interim)	p‐value (interim and post)
Use of analgesics before leaving the operating room	N = 222	N = 176	N = 204	.499	.015
Yes	39 (17.4%)	35 (19.7%)	22 (10.8%)
No	18 (82.6%)	14 (80.3%)	182 (89.2%)
Use of analgesics after operation on returning to the ward	N = 222	N = 176	N = 223	.008	.293
Yes	30 (13.5%)	40 (22.3%)	60 (26.9%)
No	193 (86.5%)	139 (77.7%)	163 (73.1%)
Use of NSAIDs after returning to the ward	N = 224	N = 179	N = 223	.000	.422
Yes	11 (4.91%)	32 (17.88%)	47 (21.08%)
No	213 (95.09%)	147 (82.12%)	176 (78.92%)
Use of tramadol after returning to the ward	N = 224	N = 179	N = 223	.030	.078
Yes	23 (10.27%)	8 (4.47%)	20 (8.79%)
No	201 (89.73%)	171 (95.53%)	203 (91.21%)
Postoperative pain score ≥ 7		N = 179	N = 223		.218
Yes		3 (1.7%)	1 (0.4%)
No		176 (98.3%)	222 (99.6%)
Postoperative nausea, vomiting, and other gastrointestinal discomfort		N = 179	N = 223		.013
Yes		48 (26.8%)	37 (16.6%)
No		131 (37.2%)	186 (83.4%)
Postoperative lower limb discomfort occurrence		N = 166	N = 140		.112
Yes		21 (12.7%)	10 (7.1%)
No		145 (87.3%)	130 (92.9%)
Postoperative dizziness occurred		N = 179	N = 223		.116
Yes		20 (11.2%)	15 (6.7%)
No		159 (88.8%)	208 (93.3%)
Intraoperative pain score		N = 75	N = 138		.077
		4.00 (4.00)	5.00 (4.00)
Pain score 15 min after the operation		N = 75	N = 138		.061
		3.00 (3.00)	3.00 (4.00)
The intraoperative pain score was reviewed 2 h after the operation		N = 75	N = 138		.217
		4.00 (3.00)	4.00 (3.00)
Duration of postoperative pain （min)		N = 75	N = 138		.032
		0.00 (30.00)	0.00 (0.00)

Data are mean (SD) or n (%) unless otherwise specified.