Barut Ovgu, Pierre-Louis Dynora, Terrazas Jose Luis, Abramovici Adi
Obstetrics and Gynecology, HCA Healthcare, Margate, USA.
Obstetrics and Gynecology, HCA Florida Northwest Hospital, Margate, USA.
Cureus. 2025 Mar 29;17(3):e81420. doi: 10.7759/cureus.81420. eCollection 2025 Mar.
This retrospective research project will assess the utilization of the Enhanced Recovery After Surgery (ERAS) protocol compared to narcotic treatment in the postoperative course of benign gynecological surgeries. We intend to study the potential relationship between the frequency of readmission rates, deep vein thrombosis (DVT), pulmonary embolism (PE), length of stay, and opioid use in the pre-discharge period in those who receive the ERAS protocol versus narcotics for pain management. The goal is also to increase the implementation of the ERAS protocol in our hospital if it is shown to be superior in this project. We hypothesize that the rate of readmission, frequency of DVT, PE, length of stay, and opioid use in the pre-discharge period will be lower in patients receiving the ERAS protocol. Female patients older than 18 years old who underwent robotic/laparoscopic/abdominal benign gynecologic surgeries in the inpatient setting between 2020 and 2023 in the HCA Florida East Division hospitals were included in this study. The analysis indicates that being in the narcotics group (incidence rate ratio (IRR) = 1.242, p = 0.001) or the ERAS + narcotics group (IRR = 1.886, p < 0.001) is associated with a significantly longer length of stay compared to the ERAS group. A grouped Charlson Index score of 1 (IRR = 1.285, p < 0.001) or 2 or higher (IRR = 2.000, p < 0.001) is also associated with a longer length of stay. Other covariates, including age, race, BMI, and smoking status, did not show statistically significant associations. The results show that being in the ERAS + narcotics group is significantly associated with increased odds of readmission (OR = 3.507, p < 0.001) compared to the ERAS group (readmission is analyzed regardless of specific diagnosis). Older age groups, specifically 45-64 years (OR = 0.574, p = 0.001) and 65 years and over (OR = 0.439, p < 0.001), are associated with lower odds of readmission compared to the 18-44 years group. Older patients may receive more comprehensive care, discharge planning, medications, and follow-ups tailored to their profile, hence returning less compared to the younger group. A grouped Charlson Index score of 1 (OR = 1.692, p = 0.019) or 2 or higher (OR = 3.086, p < 0.001) is significantly associated with increased odds of readmission. We conclude that the utilization of the ERAS protocol compared to narcotic treatment in the postoperative course of benign gynecological surgeries is superior to narcotic treatment and narcotic treatment combined with the ERAS protocol. The ERAS group was associated with shorter length of stay and decreased rates of readmission. Implementing the ERAS protocol as a standard of care is an important step shown to decrease hospital costs, improve patient outcomes, and improve hospital quality.
本回顾性研究项目将评估在良性妇科手术的术后过程中，与麻醉治疗相比，加速康复外科（ERAS）方案的应用情况。我们打算研究在接受ERAS方案与接受麻醉药物进行疼痛管理的患者中，再入院率、深静脉血栓形成（DVT）、肺栓塞（PE）的发生率、住院时间以及出院前阿片类药物使用情况之间的潜在关系。如果在本项目中显示ERAS方案更具优势，目标还包括增加其在我院的实施。我们假设接受ERAS方案的患者的再入院率、DVT发生率、PE发生率、住院时间以及出院前阿片类药物使用频率会更低。本研究纳入了2020年至2023年期间在HCA佛罗里达东部分院医院住院接受机器人/腹腔镜/腹部良性妇科手术的18岁以上女性患者。分析表明，与ERAS组相比，麻醉药物组（发病率比（IRR）=1.242，p = 0.001）或ERAS + 麻醉药物组（IRR = 1.886，p < 0.001）的住院时间显著更长。Charlson合并症指数评分为1（IRR = 1.285，p < 0.001）或2及以上（IRR = 2.000，p < 0.001）也与住院时间延长相关。其他协变量，包括年龄、种族、体重指数和吸烟状况，未显示出统计学上的显著关联。结果表明，与ERAS组相比（无论具体诊断如何分析再入院情况），ERAS + 麻醉药物组的再入院几率显著增加（OR = 3.507，p < 0.001）。与18 - 44岁组相比，年龄较大的组别，特别是45 - 64岁（OR = 0.574，p = 0.001）和65岁及以上（OR = 0.439，p < 0.001）的再入院几率较低。老年患者可能会接受更全面的护理、出院计划、药物治疗以及根据其情况量身定制的随访，因此与年轻组相比再入院的情况较少。Charlson合并症指数评分为1（OR = 1.692，p = 0.019）或2及以上（OR = 3.086，p < 0.001）与再入院几率增加显著相关。我们得出结论，在良性妇科手术的术后过程中，与麻醉治疗相比，ERAS方案的应用优于麻醉治疗以及麻醉治疗与ERAS方案联合使用。ERAS组与较短的住院时间和较低的再入院率相关。将ERAS方案作为护理标准实施是降低医院成本、改善患者预后和提高医院质量的重要一步。
