title: Enhanced Recovery Program and Length of Stay After Laparotomy on a Gynecologic Oncology Service: A Randomized Controlled Trial.
abstract: To estimate whether a rapid recovery program would reduce length of stay among patients undergoing laparotomy on a gynecologic oncology service.
  
  
  
  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.
  
  
  
  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, P=.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.
  
  
  
  When compared with usual care, introducing a formal enhanced recovery after surgery protocol did not significantly reduce length of stay.
  
  
  
  ClinicalTrials.gov, https://clinicaltrials.gov, NCT01705288.
authors.affiliation: Department of Gynecologic Oncology, Aurora Medical Group, Milwaukee, Wisconsin; and the Masonic Cancer Center and Department of Obstetrics, Gynecology and Women's Heath, University of Minnesota Twin Cities, and the Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Dickson
authors.forename: Erica
authors.initials: E
authors.lastname: Stockwell
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Geller
authors.forename: Rachel Isaksson
authors.initials: RI
authors.lastname: Vogel
authors.forename: Sally A
authors.initials: SA
authors.lastname: Mullany
authors.forename: Rahel
authors.initials: R
authors.lastname: Ghebre
authors.forename: Boris J N
authors.initials: BJ
authors.lastname: Witherhoff
authors.forename: Levi S
authors.initials: LS
authors.lastname: Downs
authors.forename: Linda F
authors.initials: LF
authors.lastname: Carson
authors.forename: Deanna
authors.initials: D
authors.lastname: Teoh
authors.forename: Michelle
authors.initials: M
authors.lastname: Glasgow
authors.forename: Matt
authors.initials: M
authors.lastname: Gerber
authors.forename: Colleen
authors.initials: C
authors.lastname: Rivard
authors.forename: Britt K
authors.initials: BK
authors.lastname: Erickson
authors.forename: Jacob
authors.initials: J
authors.lastname: Hutchins
authors.forename: Peter A
authors.initials: PA
authors.lastname: Argenta
mesh_terms: D000758:Anesthesia / Q000379:methods / Q000706:statistics & numerical data; D004434:Early Ambulation / Q000706:statistics & numerical data; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000534:rehabilitation*; D006801:Humans; D007813:Laparotomy / Q000534:rehabilitation*; D007902:Length of Stay; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D016896:Treatment Outcome