title: Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study.
abstract: OBJECTIVE
  To assess the effect of enhanced recovery pathway implementation on patient outcomes after vaginal hysterectomy (VH) performed to treat benign indications.
  
  
  METHODS
  Case-control study examining outcome measures including length of stay, pain scores, postoperative morbidity, and readmission rates after implementation of the Enhanced Recovery after Surgery (ERAS) program for VH (Canadian Task Force classification II).
  
  
  METHODS
  Teaching hospital.
  
  
  METHODS
  Fifty patients who underwent VH after implementation of ERAS were compared with 50 control patients before ERAS. Patients were matched for age, indication for surgery, American Society of Anesthesiologists grade, and surgeon.
  
  
  METHODS
  ERAS pathway.
  
  
  RESULTS
  Length of stay, percentage of patients discharged within 24 hours, use of urinary catheter and vaginal packing, and readmission rates were determined. Perioperative expenditures were compared, and cost-effectiveness of ERAS was assessed. Median patient vs control age (49.0 vs 51.0 years), parity (2.0 vs 2.0), and body mass index (26.5 vs 28.3) were statistically comparable. After ERAS implementation, the median length of stay was reduced by 51.6% (22.0 vs 45.5 hours; p < .01), and the percentage of patients discharged within 24 hours was increased by 5-fold (78.0 vs 15.6%; p < .05). Frequency of catheter use (82.0% vs 95.6%) and use of vaginal packing (52.0 vs 82.2%) were significantly lower in the post-ERAS group, and these devices were removed earlier (14.5 vs 23.7 hours and 16.0 vs 23.0 hours, respectively; p < .05 in all cases). Attendance in the Accident and Emergency Department (12.0% vs 0%; p > .05) and inpatient readmission rate (4.0% vs 0%; p > .05) were similar in both groups. Despite having to start a "gynecology school" and employ a specialist Enhanced Recovery nurse, a cost savings of 9.25% per patient was demonstrated.
  
  
  CONCLUSIONS
  The ERAS program in benign VH reduces length of stay by 51.6% and enables more women to be discharged within 24 hours, with no increase in patient readmissions rates.
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom. Electronic address: wai.yoong@nmh.nhs.uk.
authors.forename: Wai
authors.initials: W
authors.lastname: Yoong
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Viswa
authors.initials: V
authors.lastname: Sivashanmugarajan
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Sophie
authors.initials: S
authors.lastname: Relph
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Alice
authors.initials: A
authors.lastname: Bell
authors.affiliation: Department of Anaesthesia, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fajemirokun
authors.affiliation: Department of Anaesthesia, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Davies
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Kerry
authors.initials: K
authors.lastname: Munro
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Kelly
authors.initials: K
authors.lastname: Chigwidden
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Frances
authors.initials: F
authors.lastname: Evan
authors.affiliation: Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, United Kingdom.
authors.forename: Wasim
authors.initials: W
authors.lastname: Lodhi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D007902:Length of Stay; D008875:Middle Aged; D010359:Patient Readmission; D016896:Treatment Outcome
keywords: Enhanced recovery; Fast-track surgery; Vaginal hysterectomy