Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia
ObjectiveThis study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1279907/full |
| _version_ | 1827773583176237056 |
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| author | Michelle L. Kuznicki Michelle L. Kuznicki Maya Yasukawa Adrianne R. Mallen Adrianne R. Mallen Clarissa Lam Clarissa Lam Erica Eggers Erica Eggers Jefferson Regis Jefferson Regis Ali Wells Ali Wells Sarah L. Todd Sarah L. Todd Sharon E. Robertson Sharon E. Robertson Jean-Paul Tanner Matthew L. Anderson Thomas J. Rutherford |
| author_facet | Michelle L. Kuznicki Michelle L. Kuznicki Maya Yasukawa Adrianne R. Mallen Adrianne R. Mallen Clarissa Lam Clarissa Lam Erica Eggers Erica Eggers Jefferson Regis Jefferson Regis Ali Wells Ali Wells Sarah L. Todd Sarah L. Todd Sharon E. Robertson Sharon E. Robertson Jean-Paul Tanner Matthew L. Anderson Thomas J. Rutherford |
| author_sort | Michelle L. Kuznicki |
| collection | DOAJ |
| description | ObjectiveThis study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria.MethodsPatients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's t-test and non-parametric Mann–Whitney two-sample test.ResultsOf the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point.ConclusionsPPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase. |
| first_indexed | 2024-03-11T13:24:56Z |
| format | Article |
| id | doaj.art-dd74de624e9c431eb71a25e56842dd03 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-03-11T13:24:56Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-dd74de624e9c431eb71a25e56842dd032023-11-03T09:29:34ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-11-011010.3389/fsurg.2023.12799071279907Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesiaMichelle L. Kuznicki0Michelle L. Kuznicki1Maya Yasukawa2Adrianne R. Mallen3Adrianne R. Mallen4Clarissa Lam5Clarissa Lam6Erica Eggers7Erica Eggers8Jefferson Regis9Jefferson Regis10Ali Wells11Ali Wells12Sarah L. Todd13Sarah L. Todd14Sharon E. Robertson15Sharon E. Robertson16Jean-Paul Tanner17Matthew L. Anderson18Thomas J. Rutherford19Division of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesWomen’s Health Institute, The Cleveland Clinic Foundation, Cleveland, OH, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDepartment of Gynecology Oncology, Park Nicollet Methodist Hospital, Saint Louis Park, MN, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesGynecology Service, Department of Surgery, Memorial Sloan Kettering Center, New York, NY, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDepartment of Urogynecology, Cooper University Health Care, Camden, NJ, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesSchool of Medicine, St. George’s University School of Medicine, Great River, NY, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDepartment of Internal Medicine, University of Florida, Gainesville, FL, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDivision of Gynecologic Oncology, University of Louisville School of Medicine, Louisville, KY, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDivision of Gynecologic Oncology, Indiana University School of Medicine, Indianapolis, IN, United States0Department of Community and Family Health, University of South Florida College of Public Health, Tampa, FL, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesDivision of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United StatesObjectiveThis study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria.MethodsPatients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's t-test and non-parametric Mann–Whitney two-sample test.ResultsOf the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), p < 0.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1 ± 9.2 morphine milligram equivalents (MME) vs. 3.9 ± 6.9 MME, p = 0.02] and longer surgical time (114.2 ± 41 min vs. 96.8 ± 32.1 min, p = 0.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, p = 0.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, p = 0.24), and mean number of post-discharge phone calls (0 vs. 0, p = 0.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point.ConclusionsPPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea/vomiting compared to the preoperative phase.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1279907/fullERASplanned early dischargequality of lifeopioid-sparing anesthesiagynecology oncology |
| spellingShingle | Michelle L. Kuznicki Michelle L. Kuznicki Maya Yasukawa Adrianne R. Mallen Adrianne R. Mallen Clarissa Lam Clarissa Lam Erica Eggers Erica Eggers Jefferson Regis Jefferson Regis Ali Wells Ali Wells Sarah L. Todd Sarah L. Todd Sharon E. Robertson Sharon E. Robertson Jean-Paul Tanner Matthew L. Anderson Thomas J. Rutherford Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia Frontiers in Surgery ERAS planned early discharge quality of life opioid-sparing anesthesia gynecology oncology |
| title | Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia |
| title_full | Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia |
| title_fullStr | Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia |
| title_full_unstemmed | Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia |
| title_short | Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia |
| title_sort | feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid sparing anesthesia |
| topic | ERAS planned early discharge quality of life opioid-sparing anesthesia gynecology oncology |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1279907/full |
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