E-Posters-10148

10148_Chang

Pdf Summary

An enhanced recovery program (ERP) is a comprehensive approach to improving surgical outcomes and patient satisfaction by optimizing perioperative and intraoperative care. While ERPs have been successfully implemented in inpatient gynecologic surgery, their benefits have not been tested in outpatient surgical settings. This study aimed to compare patient outcomes before and after implementing an ERP for outpaent urogynecologic surgery.<br /><br />The study was a prospective non-randomized cohort quality improvement initiative. The inclusion criteria were all elective female pelvic reconstructive surgeries performed at an institutional outpatient surgery center by two urogynecology faculty. The primary outcome was patient satisfaction, and secondary outcomes included morphine milligram equivalents, IV fluids, postsurgical pain scores, postsurgical time to discharge, and costs.<br /><br />The ERP protocol involved presurgical interventions such as patient education, clear fluids intake up to two hours before arrival, and multimodal analgesia. Intraoperative interventions included no intraoperative opioids, induction with propofol, ketamine, and magnesium, and goal-directed fluid therapy. Postsurgical interventions focused on pain management with midazolam and ketamine as the first-line and opioids as the second-line option if needed. Standard discharge medications included ibuprofen, acetaminophen, and oxycodone.<br /><br />The study found that although opioid use decreased, there were no significant changes in overall patient satisfaction or postsurgical pain scores. However, there was an increase in percentile scores for satisfaction data across multiple categories. The ERP group had a significant cost savings of $396 per case, primarily attributed to decreased use of IV fluids and opioid medications. There were no significant differences in postsurgical length of stay between groups.<br /><br />These results suggest that many of the benefits demonstrated in inpatient ERP may translate to outpatient pelvic reconstructive surgery. Future work could explore the application of ERP to outpatient hysterectomy for potential additional benefits.

Keywords

enhanced recovery program

surgical outcomes

patient satisfaction

perioperative care

inpatient gynecologic surgery

outpatient surgical settings

urogynecologic surgery

patient outcomes

elective female pelvic reconstructive surgeries

outpatient surgery center