Effect of enhanced recovery after surgery on older patients undergoing transvaginal pelvic floor reconstruction surgery

1. In this randomized controlled trial, the enhanced recovery after surgery (ERAS) protocol led to a decrease in post-operative length of stay (LOS) and duration until first oral intake in an older group of women undergoing transvaginal pelvic floor reconstruction. 

Evidence Rating Level: 1 (Excellent) 

Enhanced recovery after surgery (ERAS) is a way to optimize peri-operative management by implementing strategies to reduce patient’s recovery time and decrease surgical stress levels. Previous research implementing the ERAS strategy has been focused on a variety of surgical specialties but one without robust evidence is gynecological surgery, specifically transvaginal pelvic floor reconstruction. To enhance evidence, this randomized clinical trial compared the efficacy of the ERAS protocol compared to conventional treatment in older individuals undergoing transvaginal pelvic floor reconstruction. The primary outcome was length of stay (LOS) after surgery, while the secondary outcomes included rehabilitation factors, time to first oral intake, complications, and cognitive function among others. Patients were selected if they were between 60-80 years of age, had pelvic organ prolapse and an American Society of Anesthesiologists (ASA) status of I or II. The eligible participants were randomly assigned to either the ERAS group or the conventional group in a 1:1 ratio. Each group followed their respective protocol which can be found in extensive detail in the article. Briefly, both groups had their vitals taken throughout, and the anesthesia was focused on keeping them stable. A total of 100 patients were eligible and enrolled in the study. There was a significantly shorter post-operative LOS (9 hours) for the group following the ERAS protocol compared to the conventional protocol group (74.00 (69.00, 96.00) h vs. 65.00 (59.00, 78.25) h, P = 0.001). In the ERAS group, there was a shorter length of time until the first oral intake compared to the conventional group (5.00 (2.50, 7.00) h vs. 3.00 (2.00, 4.00) h, P = 0.010). The incidence of post-operative nausea and vomiting (PONV) at 2- and 12-hours post-operatively, and the amount of post-operative pain within 2 days post-surgery was reduced by the ERAS protocol. Also affected by the ERAS protocol, the duration of post-operative airway support was reduced, allowing for less remifentanil use. One limitation of this study was the generalizability due to the use of a single cite. Despite this, the results indicate that the ERAS protocol leads to shorter post-operative LOS, and oral intake duration in this randomized controlled trial. 

Click to read the study BMC Medicine

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