# The Relationship Between Postoperative Outcomes of Gynecologic Patients After Receiving the Enhanced Recovery After Surgery (ERAS) Protocol Versus Narcotic Medication for Pain Management

## TL;DR

This study shows that using the ERAS protocol after gynecologic surgery leads to better outcomes, including shorter hospital stays and fewer readmissions, compared to using narcotics for pain management.

## Contribution

The study provides empirical evidence supporting the superiority of the ERAS protocol over narcotic-based pain management in benign gynecologic surgeries.

## Key findings

- Patients in the ERAS group had shorter hospital stays compared to those in the narcotics or ERAS + narcotics groups.
- The ERAS group had lower readmission rates compared to the ERAS + narcotics group.
- Higher Charlson Index scores were associated with longer hospital stays and increased readmission odds.

## Abstract

This retrospective research project will assess the utilization of the Enhanced Recovery After Surgery (ERAS) protocol compared to narcotic treatment in the postoperative course of benign gynecological surgeries. We intend to study the potential relationship between the frequency of readmission rates, deep vein thrombosis (DVT), pulmonary embolism (PE), length of stay, and opioid use in the pre-discharge period in those who receive the ERAS protocol versus narcotics for pain management. The goal is also to increase the implementation of the ERAS protocol in our hospital if it is shown to be superior in this project. We hypothesize that the rate of readmission, frequency of DVT, PE, length of stay, and opioid use in the pre-discharge period will be lower in patients receiving the ERAS protocol. Female patients older than 18 years old who underwent robotic/laparoscopic/abdominal benign gynecologic surgeries in the inpatient setting between 2020 and 2023 in the HCA Florida East Division hospitals were included in this study. The analysis indicates that being in the narcotics group (incidence rate ratio (IRR) = 1.242, p = 0.001) or the ERAS + narcotics group (IRR = 1.886, p < 0.001) is associated with a significantly longer length of stay compared to the ERAS group. A grouped Charlson Index score of 1 (IRR = 1.285, p < 0.001) or 2 or higher (IRR = 2.000, p < 0.001) is also associated with a longer length of stay. Other covariates, including age, race, BMI, and smoking status, did not show statistically significant associations. The results show that being in the ERAS + narcotics group is significantly associated with increased odds of readmission (OR = 3.507, p < 0.001) compared to the ERAS group (readmission is analyzed regardless of specific diagnosis). Older age groups, specifically 45-64 years (OR = 0.574, p = 0.001) and 65 years and over (OR = 0.439, p < 0.001), are associated with lower odds of readmission compared to the 18-44 years group. Older patients may receive more comprehensive care, discharge planning, medications, and follow-ups tailored to their profile, hence returning less compared to the younger group. A grouped Charlson Index score of 1 (OR = 1.692, p = 0.019) or 2 or higher (OR = 3.086, p < 0.001) is significantly associated with increased odds of readmission. We conclude that the utilization of the ERAS protocol compared to narcotic treatment in the postoperative course of benign gynecological surgeries is superior to narcotic treatment and narcotic treatment combined with the ERAS protocol. The ERAS group was associated with shorter length of stay and decreased rates of readmission. Implementing the ERAS protocol as a standard of care is an important step shown to decrease hospital costs, improve patient outcomes, and improve hospital quality.