Enhanced recovery in gynecologic surgery.

Eleftheria Kalogera, Jamie N Bakkum-Gamez, Christopher J. Jankowski, Emanuel Trabuco, Jenna K. Lovely, Sarah Dhanorker, Pamela L. Grubbs, Amy L. Weaver, Lindsey R. Haas, Bijan J Borah, April A. Bursiek, Michael T. Walsh, William Arthur Cliby, Sean Christopher Dowdy

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

To investigate the effects of enhanced recovery (a multimodal perioperative care enhancement protocol) in patients undergoing gynecologic surgery. Consecutive patients managed under an enhanced recovery pathway and undergoing cytoreduction, surgical staging, or pelvic organ prolapse surgery between June 20, 2011, and December 20, 2011, were compared with consecutive historical controls (March to December 2010) matched by procedure. Wilcoxon rank-sum, χ, and Fisher's exact tests were used for comparisons. Direct medical costs incurred in the first 30 days were obtained from the Olmsted County Healthcare Expenditure and Utilization Database and standardized to 2011 Medicare dollars. A total of 241 enhanced recovery women in the case group (81 cytoreduction, 84 staging, and 76 vaginal surgery) were compared with women in the control groups. In the cytoreductive group, patient-controlled anesthesia use decreased from 98.7% to 33.3% and overall opioid use decreased by 80% in the first 48 hours with no change in pain scores. Enhanced recovery resulted in a 4-day reduction in hospital stay with stable readmission rates (25.9% of women in the case group compared with 17.9% of women in the control group) and 30-day cost savings of more than $7,600 per patient (18.8% reduction). No differences were observed in rate (63% compared with 71.8%) or severity of postoperative complications (grade 3 or more: 21% compared with 20.5%). Similar, albeit less dramatic, improvements were observed in the other two cohorts. Ninety-five percent of patients rated satisfaction with perioperative care as excellent or very good. Implementation of enhanced recovery was associated with acceptable pain management with reduced opioids, reduced length of stay with stable readmission and morbidity rates, good patient satisfaction, and substantial cost reductions. II.

Original languageEnglish (US)
Pages (from-to)319-328
Number of pages10
JournalObstetrics and Gynecology
Volume122
Issue number2 Pt 1
StatePublished - Aug 2013

Fingerprint

Gynecologic Surgical Procedures
Perioperative Care
Patient Satisfaction
Opioid Analgesics
Length of Stay
Pelvic Organ Prolapse
Costs and Cost Analysis
Control Groups
Cost Savings
Pain Management
Health Expenditures
Medicare
Anesthesia
Databases
Morbidity
Delivery of Health Care
Pain

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Kalogera, E., Bakkum-Gamez, J. N., Jankowski, C. J., Trabuco, E., Lovely, J. K., Dhanorker, S., ... Dowdy, S. C. (2013). Enhanced recovery in gynecologic surgery. Obstetrics and Gynecology, 122(2 Pt 1), 319-328.

Enhanced recovery in gynecologic surgery. / Kalogera, Eleftheria; Bakkum-Gamez, Jamie N; Jankowski, Christopher J.; Trabuco, Emanuel; Lovely, Jenna K.; Dhanorker, Sarah; Grubbs, Pamela L.; Weaver, Amy L.; Haas, Lindsey R.; Borah, Bijan J; Bursiek, April A.; Walsh, Michael T.; Cliby, William Arthur; Dowdy, Sean Christopher.

In: Obstetrics and Gynecology, Vol. 122, No. 2 Pt 1, 08.2013, p. 319-328.

Research output: Contribution to journalArticle

Kalogera, E, Bakkum-Gamez, JN, Jankowski, CJ, Trabuco, E, Lovely, JK, Dhanorker, S, Grubbs, PL, Weaver, AL, Haas, LR, Borah, BJ, Bursiek, AA, Walsh, MT, Cliby, WA & Dowdy, SC 2013, 'Enhanced recovery in gynecologic surgery.', Obstetrics and Gynecology, vol. 122, no. 2 Pt 1, pp. 319-328.
Kalogera E, Bakkum-Gamez JN, Jankowski CJ, Trabuco E, Lovely JK, Dhanorker S et al. Enhanced recovery in gynecologic surgery. Obstetrics and Gynecology. 2013 Aug;122(2 Pt 1):319-328.
Kalogera, Eleftheria ; Bakkum-Gamez, Jamie N ; Jankowski, Christopher J. ; Trabuco, Emanuel ; Lovely, Jenna K. ; Dhanorker, Sarah ; Grubbs, Pamela L. ; Weaver, Amy L. ; Haas, Lindsey R. ; Borah, Bijan J ; Bursiek, April A. ; Walsh, Michael T. ; Cliby, William Arthur ; Dowdy, Sean Christopher. / Enhanced recovery in gynecologic surgery. In: Obstetrics and Gynecology. 2013 ; Vol. 122, No. 2 Pt 1. pp. 319-328.
@article{49fa1832370646a49169e7620706d766,
title = "Enhanced recovery in gynecologic surgery.",
abstract = "To investigate the effects of enhanced recovery (a multimodal perioperative care enhancement protocol) in patients undergoing gynecologic surgery. Consecutive patients managed under an enhanced recovery pathway and undergoing cytoreduction, surgical staging, or pelvic organ prolapse surgery between June 20, 2011, and December 20, 2011, were compared with consecutive historical controls (March to December 2010) matched by procedure. Wilcoxon rank-sum, χ, and Fisher's exact tests were used for comparisons. Direct medical costs incurred in the first 30 days were obtained from the Olmsted County Healthcare Expenditure and Utilization Database and standardized to 2011 Medicare dollars. A total of 241 enhanced recovery women in the case group (81 cytoreduction, 84 staging, and 76 vaginal surgery) were compared with women in the control groups. In the cytoreductive group, patient-controlled anesthesia use decreased from 98.7{\%} to 33.3{\%} and overall opioid use decreased by 80{\%} in the first 48 hours with no change in pain scores. Enhanced recovery resulted in a 4-day reduction in hospital stay with stable readmission rates (25.9{\%} of women in the case group compared with 17.9{\%} of women in the control group) and 30-day cost savings of more than $7,600 per patient (18.8{\%} reduction). No differences were observed in rate (63{\%} compared with 71.8{\%}) or severity of postoperative complications (grade 3 or more: 21{\%} compared with 20.5{\%}). Similar, albeit less dramatic, improvements were observed in the other two cohorts. Ninety-five percent of patients rated satisfaction with perioperative care as excellent or very good. Implementation of enhanced recovery was associated with acceptable pain management with reduced opioids, reduced length of stay with stable readmission and morbidity rates, good patient satisfaction, and substantial cost reductions. II.",
author = "Eleftheria Kalogera and Bakkum-Gamez, {Jamie N} and Jankowski, {Christopher J.} and Emanuel Trabuco and Lovely, {Jenna K.} and Sarah Dhanorker and Grubbs, {Pamela L.} and Weaver, {Amy L.} and Haas, {Lindsey R.} and Borah, {Bijan J} and Bursiek, {April A.} and Walsh, {Michael T.} and Cliby, {William Arthur} and Dowdy, {Sean Christopher}",
year = "2013",
month = "8",
language = "English (US)",
volume = "122",
pages = "319--328",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "2 Pt 1",

}

TY - JOUR

T1 - Enhanced recovery in gynecologic surgery.

AU - Kalogera, Eleftheria

AU - Bakkum-Gamez, Jamie N

AU - Jankowski, Christopher J.

AU - Trabuco, Emanuel

AU - Lovely, Jenna K.

AU - Dhanorker, Sarah

AU - Grubbs, Pamela L.

AU - Weaver, Amy L.

AU - Haas, Lindsey R.

AU - Borah, Bijan J

AU - Bursiek, April A.

AU - Walsh, Michael T.

AU - Cliby, William Arthur

AU - Dowdy, Sean Christopher

PY - 2013/8

Y1 - 2013/8

N2 - To investigate the effects of enhanced recovery (a multimodal perioperative care enhancement protocol) in patients undergoing gynecologic surgery. Consecutive patients managed under an enhanced recovery pathway and undergoing cytoreduction, surgical staging, or pelvic organ prolapse surgery between June 20, 2011, and December 20, 2011, were compared with consecutive historical controls (March to December 2010) matched by procedure. Wilcoxon rank-sum, χ, and Fisher's exact tests were used for comparisons. Direct medical costs incurred in the first 30 days were obtained from the Olmsted County Healthcare Expenditure and Utilization Database and standardized to 2011 Medicare dollars. A total of 241 enhanced recovery women in the case group (81 cytoreduction, 84 staging, and 76 vaginal surgery) were compared with women in the control groups. In the cytoreductive group, patient-controlled anesthesia use decreased from 98.7% to 33.3% and overall opioid use decreased by 80% in the first 48 hours with no change in pain scores. Enhanced recovery resulted in a 4-day reduction in hospital stay with stable readmission rates (25.9% of women in the case group compared with 17.9% of women in the control group) and 30-day cost savings of more than $7,600 per patient (18.8% reduction). No differences were observed in rate (63% compared with 71.8%) or severity of postoperative complications (grade 3 or more: 21% compared with 20.5%). Similar, albeit less dramatic, improvements were observed in the other two cohorts. Ninety-five percent of patients rated satisfaction with perioperative care as excellent or very good. Implementation of enhanced recovery was associated with acceptable pain management with reduced opioids, reduced length of stay with stable readmission and morbidity rates, good patient satisfaction, and substantial cost reductions. II.

AB - To investigate the effects of enhanced recovery (a multimodal perioperative care enhancement protocol) in patients undergoing gynecologic surgery. Consecutive patients managed under an enhanced recovery pathway and undergoing cytoreduction, surgical staging, or pelvic organ prolapse surgery between June 20, 2011, and December 20, 2011, were compared with consecutive historical controls (March to December 2010) matched by procedure. Wilcoxon rank-sum, χ, and Fisher's exact tests were used for comparisons. Direct medical costs incurred in the first 30 days were obtained from the Olmsted County Healthcare Expenditure and Utilization Database and standardized to 2011 Medicare dollars. A total of 241 enhanced recovery women in the case group (81 cytoreduction, 84 staging, and 76 vaginal surgery) were compared with women in the control groups. In the cytoreductive group, patient-controlled anesthesia use decreased from 98.7% to 33.3% and overall opioid use decreased by 80% in the first 48 hours with no change in pain scores. Enhanced recovery resulted in a 4-day reduction in hospital stay with stable readmission rates (25.9% of women in the case group compared with 17.9% of women in the control group) and 30-day cost savings of more than $7,600 per patient (18.8% reduction). No differences were observed in rate (63% compared with 71.8%) or severity of postoperative complications (grade 3 or more: 21% compared with 20.5%). Similar, albeit less dramatic, improvements were observed in the other two cohorts. Ninety-five percent of patients rated satisfaction with perioperative care as excellent or very good. Implementation of enhanced recovery was associated with acceptable pain management with reduced opioids, reduced length of stay with stable readmission and morbidity rates, good patient satisfaction, and substantial cost reductions. II.

UR - http://www.scopus.com/inward/record.url?scp=84887242948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887242948&partnerID=8YFLogxK

M3 - Article

C2 - 23969801

AN - SCOPUS:84887242948

VL - 122

SP - 319

EP - 328

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 2 Pt 1

ER -