Introducing ERAS to a Large Regional Hospital: Phase 1

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Smith, K
Nugent, R
Wu, X
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2021
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Virtual

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Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) protocols have demonstrated decreased operative complications and shortened length of stay. The ERAS Gynaecologic/Oncology guidelines outline best current evidence of perioperative care for gynaecologic surgery in the pre-operative, intraoperative and post-operative phases. Our objective was to audit current conventional care in a large regional hospital compared to current ERAS Gynaecologic/Oncology guidelines prior to implementation of an ERAS pathway.

Methods: A retrospective audit of 100 consecutive patients booked for total laparoscopic hysterectomy (TLH) was performed. Clinical and demographic information, perioperative data and patients’ post-operative course was collected from electronic medical records.

Results: 100 TLH cases were booked between July 2020 and April 2019. 84 TLHs were performed. 8% of cases converted to an open procedure. Pre-operatively, there was no documented preadmission counselling with written information. Intraoperatively, fluid administration ranged from 438 mls – 6000 mls, 100% of patients received IV opioids, and 67% received IV cefazolin only as antimicrobial prophylaxis. Post-operatively, 94% of patients were discharged Day 0–2 and 75% were discharged with opioids. 17 patients represented to emergency department within 30 days of discharge.

Discussion: This audit identifies current practises which are at greatest yield for change. Pre-operatively, greater levels of patient education and uniform documentation by medical staff is required. Intraoperatively, variance in fluid and antibiotic regimes prescribed could be improved by promoting euvolemia and considered antimicrobial usage. High rates of opioid prescription intraoperatively and post-operatively potentiates harmful persistent opioid usage. This audit identifies pre-operative, intraoperative and post-operative opportunities for improving patient outcomes by implementation of an ERAS protocol.

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Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG)

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61

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S1

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Subject

Paediatrics

Science & Technology

Life Sciences & Biomedicine

Obstetrics & Gynecology

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Smith, K; Nugent, R; Wu, X, Introducing ERAS to a Large Regional Hospital: Phase 1, Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG), 2021, 61, pp. 111-111