10/10/2018
PITTSBURGH – A recent study conducted at UPMC Magee-Womens Hospital found women of all ages undergoing surgery for pelvic organ prolapse – a common and often painful disorder in which one or more of the pelvic organs drop from their normal position – benefitted from enhanced recovery after surgery (ERAS), a pathway, or protocol, adopted to hasten recovery after surgery by decreasing pain and nausea, with shorter admissions, significantly less opioid administration and no increase in post-surgery complications.
The results of the analyses, funded in part by the National Institutes of Health and the Department of Obstetrics and Gynecology and the Clinical and Translational Science Institute of the University of Pittsburgh, will be presented at American Urogynecologic Society annual meeting on Saturday, October 13.
Last year, Magee launched a patient-focused initiative targeting a patient’s preparedness for surgery, including pre-operative interventions – such as cessation smoking, nutrition and exercise – and opioid-sparing anesthesia, intended to achieve optimal surgical outcomes. Patients engaged in this program had shorter hospital stays without any increase in 30-day post-operative complications.
The current study compared two groups cohorts of women, one who had surgery before ERAS was instituted and one after implementation, to see if the pathway benefits were the same across all age groups. All women underwent either vaginal or minimally invasive surgery for pelvic organ prolapse. Of the 382 women enrolled in the study, 25.7 percent were young (average age of 52), 52.9 percent were middle-aged (average age of 68) and 21.5 percent were older? (average age of 80).
“This is the first study in gynecology to compare ERAS outcomes in an older population to younger women,” explained Charelle Carter-Brooks, M.D., M.Sc, now of the George Washington University, who conducted the research at Magee as a urogynecology fellow. “We sought to determine if a single ERAS protocol is appropriate for women of all ages.”
The overall rate of same day discharge increased by 125 percent under ERAS for all women. Eight-five percent of older women were discharged to go home after prolapse surgery and their length of stay decreased by 58 percent from 25 hours to 9.7 hours from admission to discharge. This makes the older population as likely as their younger counterparts to benefit from the ERAS pathway.
Importantly, the total amount of opioids administered decreased across all age groups by up to 92 percent. On average, women received only 8.0 milligrams of morphine under the ERAS protocol, compared to 82.5 milligrams of morphine equivalence among those who had surgery before ERAS was implemented. Thirty-two percent of patients had an opioid-free anesthesia experience under the ERAS pathway. The decrease in opioids use after surgery is attributed to generous use of numbing medication injected into the incision sites, as well as non-narcotic pain medications.
“We often have biases about older patients, that they cannot go home the day of surgery because of pain, nausea or mobility. But we found this population can meet the same discharge milestones as younger women, enabling them to go home on the day of surgery,” Carter-Brooks said. “Protocols like ERAS can help us ensure that women can go home safely. This is a huge paradigm shift for patient care and we may need to re-think the way we view elderly patient’s post-operative recovery.
“When I share the findings of our study to patients and their families, they are very relieved and reassured that under the new ERAS clinical pathway, even our oldest patients can expect to have a safe, short admission with a very high likelihood of sleeping in their own beds the night of their surgery,” said Halina Zyczynski, M.D., professor, department of obstetrics, gynecology and reproductive sciences at Magee.