Review of enhanced recovery programs in benign gynecologic surgery

Abstract

Introduction and hypothesis

Enhanced recovery programs (ERPs) are evidence-based protocols designed to improve functional rehabilitation after surgery. ERPs have gained widespread acceptance in many surgical disciplines, and their use leads to significant improvements in patient outcomes while reducing hospital length of stay (LOS). There remains a paucity of data on the use of ERPs in benign gynecologic surgery. The purpose of this review was to evaluate current literature on the use of ERP concepts in benign gynecologic surgery.

Methods

A systematic search of PubMed, CINAHL, Web of Science, and the Cochrane databases was conducted, cross-referencing search terms related to gynecologic surgery and ERP concepts. The search was limited to publications available in English. Studies published prior to 2000, and those involving gynecologic oncology, nonadult patients, and outpatient surgery were excluded.

Results

Nine studies were included in the analysis. Due to heterogeneity of the included studies, no statistical pooling was possible and comparison between studies was limited to their respective themes. Primary study outcomes included LOS, postoperative nausea and vomiting (PONV), pain management, patient satisfaction, and hospital costs. Five studies investigated ERPs, two evaluated measures to improve PONV, and four focused on unique aspects of pain management. Across the studies, ERPs that focused on the patients’ basic symptoms and recovery were found to have equal, if not better, outcomes than standard practice.

Conclusions

This integrative review supports the implementation of ERPs in benign gynecologic surgery. The results showed that the use of ERPs decreased LOS, improved pain scores, and reduced hospital costs, without increasing perioperative complications. We suggest additional randomized controlled trials of ERP concepts in benign gynecologic surgery to support their more widespread use and application.

Appendices

Appendix 1

Table 6 Logic grid of initial search terms

Appendix 2: Example search – PubMed

(“Gynecologic Surgical Procedures”[MeSH] OR “Gynecologic Surgeries”[All Fields] OR “gynecologic surgery”[All Fields] OR “Gynaecologic surgical procedures”[All Fields] OR “hysterectomy”[MeSH] OR “hysterectomy”[All Fields] OR “uterine myomectomy”[MeSH Terms] OR “uterine myomectomy”[All Fields] OR “myomectomy”[All Fields] OR “sterilization reversal”[All Fields] OR “sterilization reversal”[MeSH Terms] OR (“sterilization”[All Fields] AND “reversal”[All Fields]) OR “sterilization reversal”[All Fields] OR “ovariectomy”[MeSH Terms] OR “ovariectomy”[All Fields] OR “oophorectomy”[All Fields] OR sacrocolpopexy[All Fields] OR “vesicovaginal fistula”[MeSH Terms] OR “vesicovaginal”[All Fields] OR “menorrhagia”[MeSH Terms] OR “menorrhagia”[All Fields] OR “metrorrhagia”[MeSH Terms] OR “metrorrhagia”[All Fields] OR “leiomyoma”[MeSH Terms] OR “leiomyoma”[All Fields] OR “fibroid”[All Fields] OR fibroid’s[All Fields] OR “endometriosis”[MeSH Terms] OR “endometriosis”[All Fields] OR “adenomyosis”[MeSH Terms] OR “adenomyosis”[All Fields] OR ((“uterus”[MeSH Terms] OR “uterus”[All Fields] OR “vagina”[MeSH Terms] OR “vagina”[All Fields] OR “vaginal”[All Fields]) AND (“prolapse”[MeSH Terms] OR “prolapse”[All Fields])) OR ((“pelvis”[MeSH Terms] OR “pelvis”[All Fields] OR “pelvic”[All Fields]) AND (“pain”[MeSH Terms] OR “pain”[All Fields])) OR ((“ovary”[MeSH Terms] OR “ovary”[All Fields] OR ovarian[All Fields]) AND (“cysts”[MeSH Terms] OR “cysts”[All Fields])) OR ((tubal[All Fields] OR tubular[All Fields] OR tube[All Fields]) AND reanastomosis[All Fields]) OR ((“Gynecology”[Mesh] OR “gynecology”[All Fields] OR “gynecology”[All Fields] OR gynecologic[All Fields] OR “gynecological”[All Fields] OR gynaecologic[All Fields] OR gynecological[All Fields]) AND (“disease”[MeSH Terms] OR “disease”[All Fields] OR “diseases”[All Fields] OR “disorder”[All Fields] OR “disorders”[All Fields] AND benign[All Fields]))) AND ((ERAS[tiab] OR “enhanced recovery after surgery”[All Fields] OR “enhanced recovery”[All Fields]) OR ((enhanced[All Fields] OR early[All Fields] OR accelerated[All Fields] OR rapid[All Fields] OR “fast track”[All Fields] OR “fast-track”[All Fields]) AND (recovery[All Fields] OR recovers[All Fields] OR recovering[All Fields] OR “rehabilitation”[MeSH Terms] OR “rehabilitation”[All Fields] OR “convalescence”[MeSH Terms] OR “convalescence”[All Fields] OR “convalesced”[All Fields] OR “convalescent”[All Fields] OR “convalescents”[All Fields] OR “mobile”[All Fields] OR “mobilization”[All Fields] OR “ambulate”[All Fields] OR “ambulation”[All Fields] OR “ambulatory”[All Fields] OR “ambulating”[All Fields] OR “walking”[MeSH Terms] OR “walking”[All Fields] OR “walk”[All Fields] OR “walks”[All Fields] OR “feeding behavior”[MeSH Terms] OR “feeding”[All Fields] OR “feed”[All Fields] OR “feeds”[All Fields] OR “nutrition”[All Fields] OR “eat”[All Fields] OR “eats”[All Fields] OR “eating”[All Fields])) AND ((((“surgery”[Subheading] OR “surgery”[All Fields] OR “surgical procedures, operative”[MeSH Terms]) OR protocol[All Fields]) OR pathway[All Fields] OR “Critical Pathways”[MeSH] OR “clinical protocols”[MeSH]) OR ((((“perioperative care”[MeSH Terms] OR “Perioperative Care”[All Fields]) OR “preoperative care”[MeSH Terms]) OR “Preoperative Care”[All Fields]) OR “Length of Stay”[MeSH] OR “Length of Stay”[All Fields]))) AND English[lang].