Same-Day Discharge After a Hysterectomy?

Enhanced Recovery After Surgery protocol at UH makes it possible

UH Clinical Update | December 2019

It wasn’t so long ago that having surgery was a momentous disruption to a person’s life, a shock to the body that would take weeks and weeks in order to achieve a complete recovery. The preparation alone was daunting, to say the least.

Thanks to Enhanced Recovery After Surgery protocols, however, this is no longer the case for many patients. These evidence-based pathways help maintain a patient’s normal physiology as much as possible, before, during and after surgery. The result is shorter length of stay, decreased complication and readmission rates and increased patient satisfaction.

At UH, minimally invasive gynecologic surgeons Megan Billow, DO, and Kimberly Gecsi, MD, and their colleagues are using an Enhanced Recovery Pathway with their patients.

“It’s a perioperative pathway that improves patients’ outcomes after surgery,” Dr. Billow says. “The idea is to maintain normal physiologic states in patients.” 

Dr. Billow lays out the steps.

“It starts with preoperative counseling,” she says. “We first provide patients with a handout in the office that discusses expectations. They also receive preoperative medications on the day of surgery that helps to reduce their pain after surgery. Intraoperatively, our anesthesia colleagues maintain a euvolemic state and administer medications for nausea and non-opioid medications for pain. Post-operatively, we use non-opioid analgesics that are scheduled, including NSAIDs and Tylenol, which has overall decreased opioid use. The patients wake up without a Foley catheter, and they’re up walking around, voiding and eating shortly after surgery.”

The minimally invasive gynecologic surgery team at UH has been using this protocol since late 2015, with impressive results.  

“It’s a national standard that most academic medical centers are using,” Dr. Billow says. “One of our biggest challenges has been implementation. We have worked diligently with our nursing and anesthesia colleagues in order to improve patient care. Everyone has been motivated and eager to enhance the care that women receive at University Hospitals. We just looked at our data, and we’re actually doing really well at implementing the program, especially in 2018.  According to this data, there was about 85 percent provider compliance with the Enhanced Recovery Pathway.”

This protocol is also making it possible for UH surgeons to offer patients the possibility of going home on the same day as their hysterectomy, Dr. Billow says.

For Dr. Billow, Dr. Gecsi and their colleagues, this protocol is just one more way to provide the highest-value care, encompassing both quality and patient satisfaction.