Enhanced recovery program and length of stay after laparotomy on a gynecologic oncology service: A randomized controlled trial

Elizabeth L. Dickson, Erica Stockwell, Melissa A. Geller, Rachel Isaksson Vogel, Sally A. Mullany, Rahel Ghebre, Boris J N Witherhoff, Levi S. Downs, Linda F. Carson, Deanna Teoh, Michelle Glasgow, Matt Gerber, Colleen Rivard, Britt K. Erickson, Jacob Hutchins, Peter A. Argenta

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Abstract

OBJECTIVE: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. METHODS: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding. A sample size of 50 per group (N=100) was planned to achieve 80% power to detect a two-day difference in our primary outcome, length of hospital stay; secondary outcomes included: total daily narcotics used, time to postoperative milestones, and complications. RESULTS: A total of 112 women were enrolled between 2013 and 2015. Nine patients did not undergo laparotomy and were excluded, leaving 52 and 51 patients in the control and intervention groups, respectively. There was no difference in length of stay between the two groups (median 3.0 in both groups; P=.36). Enhanced recovery after surgery patients used less narcotics on day 0 (10.0 compared with 5.5 morphine equivalents in the control and intervention arms, respectively, P5.09) and day 2 (10.0 compared with 7.5 morphine equivalents, respectively; P=.05); however, there was no statistically significant difference between groups in any of the secondary outcomes. Post hoc analysis based on actual anesthesia received also failed to demonstrate a difference in time to discharge. CONCLUSION: When compared with usual care, introducing a formal enhanced recovery after surgery protocol did not significantly reduce length of stay.

Original languageEnglish (US)
Pages (from-to)355-362
Number of pages8
JournalObstetrics and gynecology
Volume129
Issue number2
DOIs
StatePublished - Jan 1 2017

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Laparotomy
Length of Stay
Randomized Controlled Trials
Narcotics
Morphine
Early Ambulation
Conduction Anesthesia
Postoperative Care
Sample Size
Counseling
Anesthesia
Control Groups

Cite this

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title = "Enhanced recovery program and length of stay after laparotomy on a gynecologic oncology service: A randomized controlled trial",
abstract = "OBJECTIVE: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. METHODS: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding. A sample size of 50 per group (N=100) was planned to achieve 80{\%} power to detect a two-day difference in our primary outcome, length of hospital stay; secondary outcomes included: total daily narcotics used, time to postoperative milestones, and complications. RESULTS: A total of 112 women were enrolled between 2013 and 2015. Nine patients did not undergo laparotomy and were excluded, leaving 52 and 51 patients in the control and intervention groups, respectively. There was no difference in length of stay between the two groups (median 3.0 in both groups; P=.36). Enhanced recovery after surgery patients used less narcotics on day 0 (10.0 compared with 5.5 morphine equivalents in the control and intervention arms, respectively, P5.09) and day 2 (10.0 compared with 7.5 morphine equivalents, respectively; P=.05); however, there was no statistically significant difference between groups in any of the secondary outcomes. Post hoc analysis based on actual anesthesia received also failed to demonstrate a difference in time to discharge. CONCLUSION: When compared with usual care, introducing a formal enhanced recovery after surgery protocol did not significantly reduce length of stay.",
author = "Dickson, {Elizabeth L.} and Erica Stockwell and Geller, {Melissa A.} and Vogel, {Rachel Isaksson} and Mullany, {Sally A.} and Rahel Ghebre and Witherhoff, {Boris J N} and Downs, {Levi S.} and Carson, {Linda F.} and Deanna Teoh and Michelle Glasgow and Matt Gerber and Colleen Rivard and Erickson, {Britt K.} and Jacob Hutchins and Argenta, {Peter A.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1097/AOG.0000000000001838",
language = "English (US)",
volume = "129",
pages = "355--362",
journal = "Obstetrics and Gynecology",
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TY - JOUR

T1 - Enhanced recovery program and length of stay after laparotomy on a gynecologic oncology service

T2 - A randomized controlled trial

AU - Dickson, Elizabeth L.

AU - Stockwell, Erica

AU - Geller, Melissa A.

AU - Vogel, Rachel Isaksson

AU - Mullany, Sally A.

AU - Ghebre, Rahel

AU - Witherhoff, Boris J N

AU - Downs, Levi S.

AU - Carson, Linda F.

AU - Teoh, Deanna

AU - Glasgow, Michelle

AU - Gerber, Matt

AU - Rivard, Colleen

AU - Erickson, Britt K.

AU - Hutchins, Jacob

AU - Argenta, Peter A.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - OBJECTIVE: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. METHODS: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding. A sample size of 50 per group (N=100) was planned to achieve 80% power to detect a two-day difference in our primary outcome, length of hospital stay; secondary outcomes included: total daily narcotics used, time to postoperative milestones, and complications. RESULTS: A total of 112 women were enrolled between 2013 and 2015. Nine patients did not undergo laparotomy and were excluded, leaving 52 and 51 patients in the control and intervention groups, respectively. There was no difference in length of stay between the two groups (median 3.0 in both groups; P=.36). Enhanced recovery after surgery patients used less narcotics on day 0 (10.0 compared with 5.5 morphine equivalents in the control and intervention arms, respectively, P5.09) and day 2 (10.0 compared with 7.5 morphine equivalents, respectively; P=.05); however, there was no statistically significant difference between groups in any of the secondary outcomes. Post hoc analysis based on actual anesthesia received also failed to demonstrate a difference in time to discharge. CONCLUSION: When compared with usual care, introducing a formal enhanced recovery after surgery protocol did not significantly reduce length of stay.

AB - OBJECTIVE: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service. METHODS: We conducted a prospective, randomized, controlled trial comparing an enhanced recovery after surgery protocol with routine postoperative care among women undergoing laparotomy on the gynecologic oncology service. Protocol elements included: preoperative counseling, regional anesthesia, intraoperative fluid restriction, and early postoperative ambulation and feeding. A sample size of 50 per group (N=100) was planned to achieve 80% power to detect a two-day difference in our primary outcome, length of hospital stay; secondary outcomes included: total daily narcotics used, time to postoperative milestones, and complications. RESULTS: A total of 112 women were enrolled between 2013 and 2015. Nine patients did not undergo laparotomy and were excluded, leaving 52 and 51 patients in the control and intervention groups, respectively. There was no difference in length of stay between the two groups (median 3.0 in both groups; P=.36). Enhanced recovery after surgery patients used less narcotics on day 0 (10.0 compared with 5.5 morphine equivalents in the control and intervention arms, respectively, P5.09) and day 2 (10.0 compared with 7.5 morphine equivalents, respectively; P=.05); however, there was no statistically significant difference between groups in any of the secondary outcomes. Post hoc analysis based on actual anesthesia received also failed to demonstrate a difference in time to discharge. CONCLUSION: When compared with usual care, introducing a formal enhanced recovery after surgery protocol did not significantly reduce length of stay.

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DO - 10.1097/AOG.0000000000001838

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AN - SCOPUS:85009348149

VL - 129

SP - 355

EP - 362

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

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