Preoperative and Intraoperative Interventions for Enhanced Recovery after Gynecological Surgery
AuthorCaalim, April J.
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AbstractProblem and Purpose: Surgery causes a neuroendocrine and inflammatory stress response on the body that impairs hemostasis (Carli, 2015). Often, many of the interventions implemented during the perioperative care of patients are not evidence-based but rather due to dogmatic traditions. Enhanced recovery after surgery (ERAS) programs consist of evidence-based interventions implemented during the preoperative, intraoperative, and postoperative phases of surgery. Researchers have found that ERAS programs lead to a reduction in hospital length of stay, cost, and complications (Nelson et. al., 2016). At a community hospital in the mid-Atlantic region, anesthesia providers sought ways in which hospital length of stay and complications can be reduced in patients undergoing GYN surgery. In addition, GYN surgery is one of the most frequent types of surgical procedures performed at this institution. The purpose of this quality improvement project was to develop a clinical practice guideline (CPG) regarding ERAS for GYN surgery in order to optimize the perioperative care of patients. Methods: An expert panel was formed consisting of the chief nurse anesthetist and anesthesiologist of the institution. A need for an ERAS CPG was established based on several meetings with key stakeholders. A literature review was conducted to develop the CPG and a draft was presented to the expert panel. Next, a Non-Human Subjects Research (NHSR) review was sought from the Institutional Review Board at the University of Maryland. The Agree II Tool was utilized by the expert panel to evaluate the quality of the CPG. Feedback from the expert panel was then incorporated into the final draft. The CPG was presented to the anesthesia providers of the institution. Practitioner Feedback Questionnaires (PFQs) were distributed and anonymously collected at the end of the presentation. A descriptive statistical analysis was performed utilizing Microsoft Excel with the data obtained from the AGREE II Tool and PFQ surveys. Results: The results of the AGREE II tool were favorable with an overall calculated total domain score of 92%. The individual total domain scores are as follows: scope and purpose 97.2%, stakeholder involvement 100%, rigour of development 87.5%, clarity of presentation 94%, applicability 92.9%, and editorial independence 89.6%. The return rate for the PFQ surveys was 100% (n=15). The PFQ survey results revealed that 100% of providers believed that there is a need for an ERAS CPG for GYN surgery, that its utilization will benefit patients, and that the draft guideline recommendations will be supported by other anesthesia providers of the institution. This is indicative of the usability and wide acceptance of the CPG by the facility. Conclusion: Due to the favorable results of the AGREE II Tool and PFQ survey evaluations, it is evident that the developed ERAS CPG is of high quality and its use will be accepted at this institution.
Keywordenhanced recovery after surgery (ERAS)
Gynecological Surgical Procedures