Long-term experience with a modified ERAS protocol for urogynaecology day procedures

Area of Science:

• Uro-gynecology
• Surgical protocols
• Patient recovery

Background:

• Enhanced Recovery After Surgery (ERAS) protocols aim to reduce postoperative morbidity and length of stay.
• Standard ERAS protocols often include pre-operative high-protein diets and glucose drinks.
• These protocols are increasingly adopted in various surgical practices.

Purpose of the Study:

• To evaluate the effectiveness and safety of a modified ERAS protocol for ambulatory pelvic organ prolapse surgery.
• To assess complication and readmission rates following the implementation of a modified ERAS protocol.
• To determine the impact of omitting pre-operative carbohydrate-rich fluid intake on patient outcomes.

Main Methods:

• Retrospective audit of 1937 ambulatory pelvic organ prolapse surgeries performed between January 2008 and June 2019.
• Analysis of surgery type, postoperative complications, and readmissions.
• Implementation of a modified ERAS protocol excluding pre-operative carbohydrate-rich fluid intake.

Main Results:

• Transvaginal mesh procedures (55.8%) and posterior repairs (23.9%) were most common.
• A total of 4.4% of patients experienced complications, with failed trial of void being the most frequent (87 patients).
• Only 0.4% of patients required unplanned admission post-procedure.

Conclusions:

• A site-specific, modified ERAS protocol is effective for standardized care in outpatient uro-gynecological surgery.
• The modified protocol demonstrates safety with low complication and readmission rates.
• Further research, including multi-center randomized controlled trials, is warranted to confirm these findings and explore patient satisfaction.