Enhanced recovery pathway helpful in gyn-onc surgery

(HealthDay)—An enhanced recovery pathway is beneficial for gynecologic oncology patients undergoing minimally invasive surgery, according to a study published in the July issue of Obstetrics & Gynecology.

Jocelyn S. Chapman, M.D., from the University of California, San Francisco, and colleagues conducted a retrospective study involving gynecologic oncology patients who underwent laparoscopic or robotic surgery on an enhanced recovery pathway and were matched with historical controls. The pathway included patient education; multimodal analgesia; opioid minimization; nausea prophylaxis; and early catheter removal, ambulation, and feeding.

The final cohort included 165 patients, of whom 55 were enhanced recovery pathway patients. The researchers found that, compared with patients in the control group, enhanced recovery patients were more likely to be discharged on postoperative day one (60 versus 91 percent; odds ratio, 6.7). Fifteen and 4 percent of enhanced recovery patients and historical controls, respectively, achieved discharge by noon. Despite a 30 percent reduction in opioid use, postoperative pain scores decreased (2.6 versus 3.12). The enhanced recovery group had a 12 percent decrease in average total hospital costs ($13,771 versus $15,649). No between-group differences were seen in readmission rates, mortality, or reoperation rates.

"An enhanced recovery pathway in patients undergoing gynecologic oncology minimally invasive surgery is associated with significant improvements in recovery time, decreased pain despite reduced opioid use, and lower overall hospital costs," the authors write.