Long-term experience with a modified ERAS protocol for urogynaecology day procedures

Abstract

Enhanced recovery after surgery (ERAS) protocols were first reported for colorectal and gynaecologic procedures. The main benefits have been a shorter length of stay and reduced complications. A retrospective audit was conducted of all patients who underwent ambulatory pelvic organ prolapse surgery at the Townsville Day Surgery between January 2008 and June 2019. Following the publication of a former audit, a modified ERAS protocol was adopted at our practice. We omitted a carbohydrate-rich fluid intake prior to surgery in our local protocol. Data were analysed for the type of surgery, postoperative complications, and readmissions. All surgeries were performed by a single consultant urogynecologist. A total of 1381 women underwent 1937 surgeries. Transvaginal mesh (55.8%) was the commonest procedure, followed by a posterior repair (23.9%). Ninety-five patients (4.4%) had various complications, with a failed trial of the void as the commonest complication (87 patients). Only 8 patients (0.4%) required an unplanned admission after their procedures. Site-specific ERAS protocol is effective for providing standardised care in the surgical treatment of women with pelvic organ prolapse and urinary incontinence in an outpatient setting. Complication rates are low and reduce further with experience and familiarity with the protocol.

Impact statement:

• What is already known on this subject? Enhanced recovery after surgery (ERAS) protocols are being increasingly used in surgical practices. The main objective of the protocol has been on reducing postoperative morbidity and stay. The commonly practiced protocol includes a high protein intake diet and a glucose drink prior to surgery.

• What do the results of this study add? Our study utilises a modified ERAS protocol of omitting the high protein diet and the glucose drink for the minimally invasive uro-gynaecology procedures. The modified protocol is safe and associated with lower complications and readmission rates.

• What are the implications of these findings for clinical practice and/or further research? The present study demonstrates the safety and effectiveness of our modified ERAS protocol that allows for patients to undergo surgical procedures and discharge on the same day, thus minimising the impact on the quality of life and vocations. A multi-center randomised controlled trial will conclusively demonstrate a cause-effect relationship between early discharge and patient preparation with our modification of the ERAS protocol. Further research should also consider patient satisfaction as an additional outcome measure.

Keywords:

• ERAS
• day surgery
• gynaecology
• postoperative recovery

Disclosure statement

No potential conflict of interest was reported by the authors.