Presentation Authors: Amy Nemirovsky*, Rena D Malik, Baltimore, MD
Introduction: Enhanced recovery pathways after surgery (ERAS) have been shown to reduce surgical morbidity and length of stay across various procedures. Our objective was to provide a framework for standardized perioperative management for women undergoing abdominal sacrocolpopexy (ASC) for pelvic organ prolapse.
Methods: Following the PRISMA statement, a systematic review of the literature was conducted using Pubmed. Search terms included: Sacrocolpopexy or pelvic organ prolapse surgery and 22 ERAS elements. Eligible articles contained ERAS components and postoperative outcomes of ASC published since 2008.
Results: Of 513 abstracts identified, 33 full-text papers were included for final review. (Figure 1) ERAS items with available data specific to ASC were: patient education, medical comorbidities, preoperative bowel preparation, minimally-invasive approach (MIS), prophylactic antibiotics, epidural analgesia, postoperative: urinary drainage, ileus, analgesia and early mobilization. (Table 1) No data existed on the following elements: preanesthesia medications, venous thromboembolism, skin preparation, standard anesthetic protocol, perioperative fluid management, and prevention of postoperative nausea/vomiting. Key principles appear to be appropriate preoperative counseling with a focus on patient literacy, no benefit with preoperative bowel preparation or prophylactic antibiotic use, improved outcomes with MIS and addition of spinal anesthesia. Limiting opioid use postoperatively and early mobilization appear to be beneficial but with little supporting evidence. Early urethral catheter removal benefit is unclear.
Conclusions: There exists limited data regarding ERAS principles in perioperative care of patients undergoing ASC. Additional prospective studies with implementation of these principles are needed to assess impact on postoperative care of these patients.