Enhanced Recovery Program for Outpatient Female Pelvic Reconstructive Surgery

Area of Science:

• Perioperative Medicine
• Pelvic Reconstructive Surgery
• Quality Improvement Initiatives

Background:

• Enhanced recovery programs (ERPs) are evidence-based protocols aimed at optimizing surgical patient care.
• ERPs are known to reduce narcotic use, shorten hospital stays, lower costs, and improve patient satisfaction.
• Outpatient procedures in female pelvic medicine and reconstructive surgery are increasing, necessitating outcome optimization.

Purpose of the Study:

• To compare patient outcomes before and after the implementation of an ERP for women undergoing outpatient pelvic reconstructive surgery.
• To evaluate the impact of an ERP on opioid consumption, pain scores, and resource utilization.
• To assess the effectiveness of ERPs in the specific context of female pelvic reconstructive surgery.

Main Methods:

• A prospective, nonrandomized cohort quality improvement initiative was conducted.
• The intervention group comprised 66 patients undergoing elective outpatient pelvic reconstructive surgery post-ERP implementation.
• Historical controls included 124 patients who underwent similar procedures prior to ERP implementation.

Main Results:

• A reduction in intraoperative and total opioid use (measured in morphine milligram equivalents - MMEs) was observed in the ERP group.
• No significant difference was found in postoperative pain scores between the ERP and control groups.
• The ERP group demonstrated a shorter procedure length, reduced intraoperative intravenous fluid administration, and lower total hospital costs.

Conclusions:

• Implementation of an outpatient ERP for female pelvic reconstructive surgery is associated with significant benefits.
• These benefits include decreased intraoperative and total opioid requirements, reduced procedure length, and lower hospital costs.
• Importantly, these improvements were achieved without compromising postoperative pain management.