Enhanced Recovery After Surgery Outcomes in Minimally Invasive Non-Hysterectomy Gynecologic Procedures

Abstract Background Improved patient outcomes and satisfaction associated with enhanced recovery after surgery protocols have increasingly replaced traditional peri-operative anesthesia care. Fast-track surgery pathways have been extensively validated in patients undergoing hysterectomies, yet impact on fertility-sparing laparoscopic gynecologic operations, particularly those addressing chronic pain conditions, has not been examined. Objective To determine the effects of enhanced recovery after surgery pathway implementation compared to conventional peri-operative care in women undergoing laparoscopic minimally invasive non-hysterectomy 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 peri-operative 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 pre-operative anti-emetic medication administration in the enhanced recovery after surgery group resulted in a 57% reduction in post-anesthesia care unit anti-emetics (P Conclusion Enhanced recovery after surgery implementation resulted in increased same day discharge rates and improved peri-operative outcomes without affecting 30-day morbidity in women undergoing laparoscopic minimally invasive non-hysterectomy gynecologic procedures.