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A Full Enhanced Recovery After Surgery Program in Gynaecologic Laparoscopic Procedures: A Randomized Controlled Trial
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  • Yuan Ren,
  • Dawei Sun,
  • Lijian Pei,
  • Xia Liu,
  • Ying Liu,
  • Haiyuan Liu
Yuan Ren
Peking Union Medical College Hospital
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Dawei Sun
Peking Union Medical College Hospital Department of Obstetrics and Gynecology
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Lijian Pei
Peking Union Medical College Hospital Department of Anesthesiology
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Xia Liu
Peking Union Medical College Hospital Department of Obstetrics and Gynecology
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Ying Liu
Peking Union Medical College Hospital Department of Obstetrics and Gynecology
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Haiyuan Liu
Peking Union Medical College Hospital Department of Obstetrics and Gynecology
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Abstract

Objective To assess whether a full enhanced recovery after surgery (ERAS) program can further reduce perioperative outcomes among patients undergoing gynaecologic laparoscopic procedures relative to those undergoing limited ERAS management. Design Single-center, open-label, randomized trial. Setting A tertiary hospital, China: December 2018 to October 2019. Population One hundred and forty-four women scheduled for an elective simple gynaecologic laparoscopic surgery. Methods Patients were randomized into two groups: full ERAS intervention or limited ERAS management. Primary outcome Postoperative length of stay (LOS). Results Postoperative LOS for the full ERAS program showed a 1-day reduction in comparison to the limited ERAS group (median of 1.0 day versus 2.0 days, respectively; P = .002). Multivariate regression analysis identified preoperative carbohydrate loading and opioid-sparing analgesia as the independent factors for discharging on postoperative day (POD) 1. Patients in the full ERAS program reported less postoperative pain within 72 hours postoperatively and had a lower narcotic consumption rate compared with those in the limited ERAS management. They also enjoyed better and faster recovery as demonstrated by the QoR-15 scale on POD 3: median of 137.0 for full ERAS program versus 130.0 for limited ERAS management, respectively (P = .020). There were no significant differences between groups regarding postoperative complication rate, readmission rate, or in-hospital cost. Conclusion The addition of full ERAS management can further reduce postoperative length of stay and improve patients’ quality of life after laparoscopic surgery for gynaecologic diseases. Keywords enhanced recovery after surgery, perioperative management, gynaecologic laparoscopic surgery, length of stay.