Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery

Abstract

Objective To explore the safety and feasibility of the application of day surgery management model under enhanced recovery after surgery (ERAS) concept in patients undergoing gynecologic laparoscopic surgery. Methods A non-randomized concurrent control trial was conducted on the patients who underwent laparoscopic surgery in our department from January to August 2021. A total of 92 patients admitted on odd date were assigned into Ward B of our department and served as the control group, and another 96 patients hospitalized on even date were subjected into Ward A and served as the observation group. The control group was given the routine treatment schedule, including the relevant examinations after admission and general operation procedure during hospitalization. The observation group was under a day surgery management model based on the concept of ERAS, with aid of a day surgery team and optimized perioperative management measures, including pre-hospital rehabilitation, shortening water fasting before surgery, multi-mode analgesia, preventive antiemesis, intraoperative warmth, prevention of deep vein thrombosis, immediate postoperative eating and activity, and follow-up after discharge. Postoperative subjective comfort, intestinal function recovery, social and economic benefits, postoperative complications and inflammatory indicators were compared between the 2 groups. Results In 0~6, 7~12 and 13~24 h after operation, the scores of thirst, hunger, nausea, pain, abdominal distension and pharyngeal discomfort were significantly lower in the observation group than the control group (P < 0.01). The observation group had obviously shorter length of hospital stay and ealier bowel sound recovery and first anal exhaust than the control group (P < 0.01). No postoperative complication, such as fall, unplanned secondary operation or wound infection was observed in both groups. The postoperative inflammatory indicators, including procalcitonin (PCT), neutrophil percentage (Neu%) and white blood cell count (WBC) were all in the normal ranges in the 2 groups at 24 h and 3 and 7 d after surgery. Statistical differences were found in firstly postoperative mobilization, length of hospital stay, hospitalization cost and patient satisfaction between the 2 groups (P < 0.01). Conclusion ERAS-based day surgery management model has the advantages of shortening hospital stay, reducing medical costs, promoting postoperative rehabilitation, and improving the comfort and satisfaction in patients undergoing gynecologic laparoscopic surgery.

Keywords

• day surgery
• rapid recovery
• gynecologic laparoscopy
• day ward
• utenine fibroid