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1954 Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Surgical Outcomes and Opioid Prescription Patterns in Patients Undergoing Minimally Invasive Hysterectomy: A Safety-Net Teaching Hospital Experience
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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Measurements and Main Results: 241 women met inclusion criteria. Complete follow-up was achieved in 199 (82.57%) women, of them 82, 89 and 28 underwent laparoscopic, laparotomy and hysteroscopic myomectomy, respectively. There were no significant differences between the groups in women’s age, BMI, gravidity and history of cesarean deliveries. Endometrial damage during laparoscopy and laparotomy was reported in 3 (3.6%) and 7 (7.8%) of the women, respectively (p=0.21), and in all women undergoing hysteroscopic myomectomy (p=0.001). During subsequent pregnancy, morbidly adherent placenta was suspected in only one woman in each of the groups (p=0.63), a rate that is considered lower than the reported rate after one cesarean delivery. Placenta previa was not seen in any of the women included in the study. Normal vaginal delivery was significantly higher in the hysteroscopy group compared to laparoscopy and laparotomy groups [11 (36.3%) vs. 5 (6.1%) vs. 4 (4.5%); p=0.001], with significantly lower need for manual lysis of the placenta [11(39.0%) vs. 51 (62.1%) vs. 62 (69.7%); p=0.01] and no need for any further interventions to control blood loss. Conclusion: Subsequent pregnancy after myomectomy was not found to be associated with high placental abnormality rate. Furthermore, other than manual lysis, no difference in abnormal placentation requiring intervention was seen between the different techniques.
Design: Retrospective chart review including all hysterectomies performed one year before and one year after the implementation of the ERAS bundle. Setting: Teaching county hospital in Texas. Patients or Participants: All patients undergoing hysterectomy from 1/1/ 17-12/31/18. Interventions: ERAS components included: 1- Preoperative carbohydrate loading, Preemptive anesthesia, 2- Intraoperative fluid and narcotic restriction and regional anesthesia, 3- Postoperative early feeding and ambulation. Measurements and Main Results: 474 patients were included in the study, 51% before and 49% after ERAS. Route of surgery included 36% vaginal, 33 % laparoscopic and 30% open hysterectomy. Patient characteristics were similar between groups. Surgical outcomes as well as opioid prescription at discharge measured in Morphine Milli-Equivalents (MME) were recorded and compared before and after the intervention. After ERAS implementation, more regional blocks were performed in open hysterectomies: 6% vs 20%, p<0.001 and successful intraoperative fluid restriction was achieved in laparoscopic and open hysterectomies (p=0.045, p<0.001respectively). LOS was significantly shorter after ERAS in all categories of hysterectomies (P<0.01). Same day discharge increased from 16% in vaginal and laparoscopic hysterectomies to 40% and 38% respectively. No significant difference in surgical duration, blood loss, postoperative complications, emergency room (ER) visits and readmissions was noted between groups, however, opioid prescription at the time of discharge decreased significantly from 150 to 123 MME, p<0.01, 174 to 130 MME, p<0.001, 188 to 147 MME (p<0.003) in vaginal, laparoscopic and abdominal hysterectomies respectively. Conclusion: ERAS implementation in a safety net teaching hospital was associated with decreased LOS with no increase in complications, ER visits or readmissions in hysterectomy cases while decreasing opioid prescription at the time of discharge.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION K 2576 Right Sided Cornual Ectopic Pregnancy after Right Salpingectomy Arora A,* Saxena A, Jaiswal E, Teja GND. Tulip Multispeciality Hospital Pvt. Ltd, Sonepat, India *Corresponding author. Video Objective: To present our experience of laparoscopic management of cornual ectopic pregnancy. Setting: Tulip Multispeciality Hospital. Interventions: Laparoscopic surgery as a treatment modality for cornual pregnancy. Laparoscopic wedge resection was carried out for corneal pregnancy. A circumferential incision was made above the base of the cornual pregnancy thus leaving behind sufficient serosal and myometrial tissue for closure with minimal distortion to the uterus. After extirpation of the cornual pregnancy, the myometrial defect was reconstituted with Vicryl 1-0 in two layers. Hemostasis was achieved by suturing. Conclusion: We have to be aware that conual pregnancy can be presented even after salpingectomy and laparoscopic approach for cornual ectopic is minimally invasive, safe procedure if performed by a confident and experienced surgeon. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION L 1954 Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Surgical Outcomes and Opioid Prescription Patterns in Patients Undergoing Minimally Invasive Hysterectomy: A Safety-Net Teaching Hospital Experience Jalloul RJ,1 Simpson I,1,* Lin AS,2 Cotton S,2 Elshatanoufy S1. 1Obstetrics and Gynecology, University of Texas Health Science Center in Houston, Houston, TX; 2McGovern Medical School, Houston, TX *Corresponding author. Study Objective: To evaluate the effect of ERAS bundle implementation on surgical duration, blood loss, length of stay (LOS), 30-day readmission, complication rates as well as opiates prescribing pattern at discharge in patients undergoing hysterectomy.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION M 1475 Laparoscopic Intracapsular Myomectomy for Deep Intramural Myomas in Infertile Women Tandulwadkar SR*. Centre of Excellence Infertility & Endoscopy, Dr. Tandulwadkar’s Solo Clinic, Pune, India *Corresponding author. Video Objective: Laparoscopic Intracapsular Myomectomy helps in avoiding the opening of uterine cavity in infertile women with deep intramural myomas compressing the cavity. Infertile women with deep intramural myomas compressing the cavity, laparoscopic intracapsular myomectomy may be preferred to avoid opening the uterine cavity. Setting: Videos of 3 cases will be shown where infertile women needed Myomectomy to optimize fertility results Case A 33 year old woman with 3 deep intramural medium sized myomas compressing the cavity from three sides. Case B 31 year old woman, with large posterior wall intramural myoma compressing the cavity from fundus to isthmus. Case C 28 year old, regular cycles, showing 6cm by 8cm right lateral wall myoma, compressing the cavity. Interventions: 3 cases demonstrating our objective are shown. In all the cases you will notice. we remained in the intracapsular plane finer fibers of the capsule were also cut so as to make myoma absolutely naked Intracapsular plane is the most avascular plane cavity was not opened
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Measurements and Main Results: 241 women met inclusion criteria. Complete follow-up was achieved in 199 (82.57%) women, of them 82, 89 and 28 underwent laparoscopic, laparotomy and hysteroscopic myomectomy, respectively. There were no significant differences between the groups in women’s age, BMI, gravidity and history of cesarean deliveries. Endometrial damage during laparoscopy and laparotomy was reported in 3 (3.6%) and 7 (7.8%) of the women, respectively (p=0.21), and in all women undergoing hysteroscopic myomectomy (p=0.001). During subsequent pregnancy, morbidly adherent placenta was suspected in only one woman in each of the groups (p=0.63), a rate that is considered lower than the reported rate after one cesarean delivery. Placenta previa was not seen in any of the women included in the study. Normal vaginal delivery was significantly higher in the hysteroscopy group compared to laparoscopy and laparotomy groups [11 (36.3%) vs. 5 (6.1%) vs. 4 (4.5%); p=0.001], with significantly lower need for manual lysis of the placenta [11(39.0%) vs. 51 (62.1%) vs. 62 (69.7%); p=0.01] and no need for any further interventions to control blood loss. Conclusion: Subsequent pregnancy after myomectomy was not found to be associated with high placental abnormality rate. Furthermore, other than manual lysis, no difference in abnormal placentation requiring intervention was seen between the different techniques.
Design: Retrospective chart review including all hysterectomies performed one year before and one year after the implementation of the ERAS bundle. Setting: Teaching county hospital in Texas. Patients or Participants: All patients undergoing hysterectomy from 1/1/ 17-12/31/18. Interventions: ERAS components included: 1- Preoperative carbohydrate loading, Preemptive anesthesia, 2- Intraoperative fluid and narcotic restriction and regional anesthesia, 3- Postoperative early feeding and ambulation. Measurements and Main Results: 474 patients were included in the study, 51% before and 49% after ERAS. Route of surgery included 36% vaginal, 33 % laparoscopic and 30% open hysterectomy. Patient characteristics were similar between groups. Surgical outcomes as well as opioid prescription at discharge measured in Morphine Milli-Equivalents (MME) were recorded and compared before and after the intervention. After ERAS implementation, more regional blocks were performed in open hysterectomies: 6% vs 20%, p<0.001 and successful intraoperative fluid restriction was achieved in laparoscopic and open hysterectomies (p=0.045, p<0.001respectively). LOS was significantly shorter after ERAS in all categories of hysterectomies (P<0.01). Same day discharge increased from 16% in vaginal and laparoscopic hysterectomies to 40% and 38% respectively. No significant difference in surgical duration, blood loss, postoperative complications, emergency room (ER) visits and readmissions was noted between groups, however, opioid prescription at the time of discharge decreased significantly from 150 to 123 MME, p<0.01, 174 to 130 MME, p<0.001, 188 to 147 MME (p<0.003) in vaginal, laparoscopic and abdominal hysterectomies respectively. Conclusion: ERAS implementation in a safety net teaching hospital was associated with decreased LOS with no increase in complications, ER visits or readmissions in hysterectomy cases while decreasing opioid prescription at the time of discharge.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION K 2576 Right Sided Cornual Ectopic Pregnancy after Right Salpingectomy Arora A,* Saxena A, Jaiswal E, Teja GND. Tulip Multispeciality Hospital Pvt. Ltd, Sonepat, India *Corresponding author. Video Objective: To present our experience of laparoscopic management of cornual ectopic pregnancy. Setting: Tulip Multispeciality Hospital. Interventions: Laparoscopic surgery as a treatment modality for cornual pregnancy. Laparoscopic wedge resection was carried out for corneal pregnancy. A circumferential incision was made above the base of the cornual pregnancy thus leaving behind sufficient serosal and myometrial tissue for closure with minimal distortion to the uterus. After extirpation of the cornual pregnancy, the myometrial defect was reconstituted with Vicryl 1-0 in two layers. Hemostasis was achieved by suturing. Conclusion: We have to be aware that conual pregnancy can be presented even after salpingectomy and laparoscopic approach for cornual ectopic is minimally invasive, safe procedure if performed by a confident and experienced surgeon. Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION L 1954 Effect of Enhanced Recovery After Surgery (ERAS) Implementation on Surgical Outcomes and Opioid Prescription Patterns in Patients Undergoing Minimally Invasive Hysterectomy: A Safety-Net Teaching Hospital Experience Jalloul RJ,1 Simpson I,1,* Lin AS,2 Cotton S,2 Elshatanoufy S1. 1Obstetrics and Gynecology, University of Texas Health Science Center in Houston, Houston, TX; 2McGovern Medical School, Houston, TX *Corresponding author. Study Objective: To evaluate the effect of ERAS bundle implementation on surgical duration, blood loss, length of stay (LOS), 30-day readmission, complication rates as well as opiates prescribing pattern at discharge in patients undergoing hysterectomy.
Virtual Poster Session 1: Laparoscopy (10:20 AM — 10:30 AM) 10:20 AM: STATION M 1475 Laparoscopic Intracapsular Myomectomy for Deep Intramural Myomas in Infertile Women Tandulwadkar SR*. Centre of Excellence Infertility & Endoscopy, Dr. Tandulwadkar’s Solo Clinic, Pune, India *Corresponding author. Video Objective: Laparoscopic Intracapsular Myomectomy helps in avoiding the opening of uterine cavity in infertile women with deep intramural myomas compressing the cavity. Infertile women with deep intramural myomas compressing the cavity, laparoscopic intracapsular myomectomy may be preferred to avoid opening the uterine cavity. Setting: Videos of 3 cases will be shown where infertile women needed Myomectomy to optimize fertility results Case A 33 year old woman with 3 deep intramural medium sized myomas compressing the cavity from three sides. Case B 31 year old woman, with large posterior wall intramural myoma compressing the cavity from fundus to isthmus. Case C 28 year old, regular cycles, showing 6cm by 8cm right lateral wall myoma, compressing the cavity. Interventions: 3 cases demonstrating our objective are shown. In all the cases you will notice. we remained in the intracapsular plane finer fibers of the capsule were also cut so as to make myoma absolutely naked Intracapsular plane is the most avascular plane cavity was not opened