A Full Enhanced Recovery After Surgery Program in Gynaecologic
Laparoscopic Procedures: A Randomized Controlled Trial
Abstract
Objective To assess whether a full enhanced recovery after surgery
(ERAS) program can further reduce perioperative outcomes among patients
undergoing gynaecologic laparoscopic procedures relative to those
undergoing limited ERAS management. Design Single-center, open-label,
randomized trial. Setting A tertiary hospital, China: December 2018 to
October 2019. Population One hundred and forty-four women scheduled for
an elective simple gynaecologic laparoscopic surgery. Methods Patients
were randomized into two groups: full ERAS intervention or limited ERAS
management. Primary outcome Postoperative length of stay (LOS). Results
Postoperative LOS for the full ERAS program showed a 1-day reduction in
comparison to the limited ERAS group (median of 1.0 day versus 2.0 days,
respectively; P = .002). Multivariate regression analysis identified
preoperative carbohydrate loading and opioid-sparing analgesia as the
independent factors for discharging on postoperative day (POD) 1.
Patients in the full ERAS program reported less postoperative pain
within 72 hours postoperatively and had a lower narcotic consumption
rate compared with those in the limited ERAS management. They also
enjoyed better and faster recovery as demonstrated by the QoR-15 scale
on POD 3: median of 137.0 for full ERAS program versus 130.0 for limited
ERAS management, respectively (P = .020). There were no significant
differences between groups regarding postoperative complication rate,
readmission rate, or in-hospital cost. Conclusion The addition of full
ERAS management can further reduce postoperative length of stay and
improve patients’ quality of life after laparoscopic surgery for
gynaecologic diseases. Keywords enhanced recovery after surgery,
perioperative management, gynaecologic laparoscopic surgery, length of
stay.