Is recovery really 'enhanced' through enhanced recovery programs? An analysis of patient-reported perioperative symptom burden before and after implementation of an enhanced recovery pathway for gynecologic surgery

2016 ◽  
Vol 141 ◽  
pp. 15-16 ◽  
Author(s):  
L.A. Meyer ◽  
A.M. Nick ◽  
M.D. Iniesta ◽  
K.E. Cain ◽  
T.W. Earles ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Symptom Burden ◽  
Gynecologic Surgery ◽  
Enhanced Recovery Pathway ◽  
Recovery Programs ◽  
Patient Reported ◽  
Before And After ◽  
Enhanced Recovery Programs

Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery

2021 ◽  
pp. ijgc-2021-002674
Author(s):  
Sarah Huepenbecker ◽  
Robert Tyler Hillman ◽  
Maria D Iniesta ◽  
Tsun Chen ◽  
Katherine Cain ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Symptom Burden ◽  
Equivalent Dose ◽  
Hospital Length Of Stay ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Opioid Prescribing ◽  
Patient Reported ◽  
Morphine Equivalent

ObjectiveTo compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.MethodsWe compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan–Meier curves for symptom recovery.ResultsAmong 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.ConclusionsAfter implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.

Review of enhanced recovery programs in benign gynecologic surgery

2017 ◽  
Vol 29 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Elisa R. Trowbridge ◽  
Caitlin N. Dreisbach ◽  
Bethany M. Sarosiek ◽  
Catherine Page Dunbar ◽  
Sarah Larkin Evans ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Gynecologic Surgery ◽  
Recovery Programs ◽  
Enhanced Recovery Programs

scholarly journals Longitudinal patient-reported outcomes and restrictive opioid prescribing after minimally invasive gynecologic surgery

2020 ◽  
Vol 31 (1) ◽  
pp. 114-121
Author(s):  
R. Tyler Hillman ◽  
Maria D Iniesta ◽  
Qiuling Shi ◽  
Tina Suki ◽  
Tsun Chen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Statistical Significance ◽  
Symptom Burden ◽  
Gynecologic Surgery ◽  
Post Discharge ◽  
Opioid Prescribing ◽  
Median Reduction ◽  
Significant Difference ◽  
Patient Reported ◽  
Before And After

ObjectiveTo determine post-discharge patient-reported symptoms before and after implementation of restrictive opioid prescribing among women undergoing minimally invasive gynecologic surgery.MethodsWe compared clinical outcomes and symptom burden among a cohort of 389 women undergoing minimally invasive gynecologic surgery at a single institution before and after implementation of a restrictive opioid prescribing quality improvement initiative in July 2018. Post-discharge symptom burdens were collected up to 42 days after discharge using the MD Anderson Symptom Inventory and analyzed using linear mixed effects models.ResultsThe majority of women included in this study were white non-smokers and the median age was 55 (range 23–83). Most women underwent hysterectomy (64%), had surgery for malignancy (71%), and were discharged from the hospital on the day of surgery (65%). Women in the restrictive opioid prescribing group had a median reduction in morphine equivalent dose prescribed at discharge of 83%, corresponding to a median reduction in 25 tablets of 5 mg oxycodone per person. There was no difference between opioid prescribing groups in either the rate of refill requests (P=1) or hospital re-admission (P=1) up to 30 days after discharge. After adjustment for co-variates, there was no statistically significant difference in post-discharge symptom burden including patient-reported pain (P=0.08), sleep (P=0.30), walking interference (P=0.64), activity interference (P=0.12), or affective interference (P=0.67). There was a trend toward less reported constiptation in the restrictive opioid prescribing group that did not reach statistical significance (P=0.05).ConclusionWe found that restrictive post-operative opioid prescribing was not associated with differences in longitudinal symptom burden among women undergoing minimally invasive gynecologic surgery. These results provide the most comprehensive picture to date of post-operative symptom recovery under different opioid prescribing approaches, lending additional support for existing recommendations to reduce opioid prescribing following gynecologic surgery.

Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
pp. 000313482095484
Author(s):  
Andrés Zorrilla-Vaca ◽  
Gabriel E. Mena ◽  
Juan Cata ◽  
Ryan Healy ◽  
Michael C. Grant
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Observational Studies ◽  
Enhanced Recovery ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Conventional Care ◽  
Recovery Programs ◽  
Enhanced Recovery Programs ◽  
Postoperative Aki

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.

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