Enhanced Recovery Program for Outpatient Female Pelvic Reconstructive Surgery

Enhanced recovery programs (ERPs) are evidence-based perioperative interventions designed to reduce narcotic use, decrease hospital length of stay, decrease medical costs, and improve patient satisfaction. Given the increase in outpatient procedures in female pelvic medicine and reconstructive surgery, we sought to compare patient outcomes before and after implementation of an ERP for women undergoing outpatient pelvic reconstructive surgery.

This was a prospective nonrandomized cohort quality improvement practice initiative. The ERP intervention group included consecutive patients (n = 66) undergoing elective outpatient pelvic reconstructive surgery from March 2016 to October 2016. Historical controls were consecutive patients (n = 124) who had undergone outpatient pelvic reconstructive surgery in the same period a year before ERP implementation. Our primary outcome was opioid use and postoperative pain scores. Secondary outcomes included procedure time, use of intravenous fluids, time to discharge, and total hospital cost.

There was an observed reduction in opioid use between the ERP patients and historic controls as measured by intraoperative morphine milligram equivalents (MMEs) and total MMEs, with no difference in postoperative pain scores or postoperative MME. In addition, reduction in length of procedure (P = 0.03), intraoperative intravenous fluids (P < 0.0001), and total hospital cost (P ≤ 0.01) was noted between the ERP patients and historic controls.

Implementation of an outpatient ERP for female pelvic reconstructive surgery was associated with decreased intraoperative and total MMEs, decreased length of procedure, decreased administration of intravenous fluids, and decreased total hospital cost without changing postoperative pain scores.