Abstract
Introduction and hypothesis
The aim of this study was to describe patient experiences with an enhanced recovery protocol (ERP) after minimally invasive sacrocolpopexy (SCP).
Methods
We conducted 14 semi-structured telephone interviews with women who had undergone SCP and were discharged the day of the surgery (POD#0, n = 7) or spent 1 night at the hospital (POD#1, n = 7). Interviews occurred between 2 and 6 weeks after surgery. We explored the following topics: patient preparedness, preoperative education, physical recovery, emotional recovery, and overall perception of the ERP. Interviewing continued until thematic saturation was achieved. All interviews were recorded, transcribed, and analyzed to identify relevant themes.
Results
Both POD#0 and POD#1 discharge patients reported largely positive experiences regarding their preparation for surgery, at-home recovery, and access to follow-up care. Yet for some patients, the accelerated pace of the ERP felt rushed and was perceived as an absence of care rather than as an advance in treatment. Patients that elected to stay the night lived farther from ready access to care, had less robust systems of postoperative support, and worried more about the management of their pre-existing conditions.
Conclusions
Our research found that despite having consistently positive impressions of the ERP, patients shared common anxieties surrounding their surgeries including worries about access to care and the prospect of going home with a urinary catheter. Furthermore, we found that the therapeutic value of protocol recommendations such as early discharge must be made explicit to patients and often individualized to avoid being interpreted as sub-standard care.
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References
Kalogera E, Bakkum-Gamez JN, Jankowski CJ, et al. Enhanced recovery in gynecologic surgery. Obstet Gynecol. 2013;122:319–28.
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;83:630–41.
Kalogera E, Dowdy SC. Enhanced recovery pathway in gynecologic surgery: improving outcomes through evidence-based medicine. Obstet Gynecol Clin N Am. 2016;43:551–73.
Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology. Gynecol Oncol. 2014;135:586–94.
Carter-brooks CM, Du AL, Ruppert KM, et al. Implentation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway. Am J Obstet Gynecol. 2018;219(5):495.
Trowbridge ER, Evans SL, Sarosiek BM, et al. Enhanced recovery program for minimally invasive and vaginal urogynecologic surgery. Int Uorgynecol J. 2019;30(2):313–21.
Perioperative pathways: enhanced recovery after surgery. ACOG Committee Opinion No. 750. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e120–e130.
Blazeby JM, Soulsby M, Winstone K, et al. A qualitative evaluation of patients’ experiences of an enhanced recovery programme for colorectal cancer. Color Dis. 2010;12:236–42.
Gillis C, Gill M, Marlett N, et al. Patient as partners in enhanced recovery after surgery: a qualitative patient-led study. BMJ Open. 2017;7:1–10.
Cohen M, Liu Y. Ko C et al an examination of American College of Surgeons NSQIP surgical risk calculator accuracy. J Am Coll Surg. 2017;224(5):787–95.
Grossoehme DH. Research methodology overview of qualitative research. J Health Care Chaplain. 2014;20(3):109–22.
Galli E, Fagnani C, Laurora I, et al. Enhanced recovery after surgery (ERAS) multimodal programme as experienced by pancreatic surgery patients: findings from an Italian qualitative study. Int J Surg. 2015;23:152–9.
Archer S, Montague J, Bali A. Exploring the experience of an enhanced recovery programme for gynecological cancer patients: a qualitative study. Perioper Med (Lond). 2014;3:1–8.
Phillips E, Archer S, Montague J, et al. Experiencees of enhanced recovery after surgery in general gynaecology patients: an interpretative phenomenological analysis. Health Psychol Open. 2019;6(2):20551029860635.
Shatkin-Margolis A, Yook E, Hill A, et al. Self-removal of a urianry catheter after urogynecologic surgery: a randomized controlled trial. Obstet Gynecol. 2019;134(5):1027–36.
Kisby CK, Polin MR, Visco AG, et al. Same-day discharge after robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2019;25(5):337–41.
Evans S, Yoder C, Brown J, et al. Gynecologic surgeons’ perceptions of same-day discharge after minimally invasive hysterectomy and sacrocolpopexy. Abstract. Oral presentation presented at 2019 AUGS/IUGA. Nashville, TN.
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Authors and Affiliations
Contributions
Evans: Protocol/project development, Data analysis, Manuscript writing, Manuscript editing.
Snook: Protocol/project development, Data collection, Manuscript editing.
Yates: Protocol/project development, Data collection, Data analysis, Manuscript editing.
Bundy: Data analysis, Manuscript writing, Manuscript editing.
Abimbola: Data collection.
Myers: Protocol/project development, Manuscript editing.
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Funding for this study was provided by the Department of Obstetrics and Gynecology Research Fund at Atrium Health.
Erinn Myers, MD: Boston Scientific, research support; Intuitive Surgical, Cadaver Lab.
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Evans, S., Snook, L., Yates, T. et al. Patient experience with enhanced recovery and early discharge after minimally invasive sacrocolpopexy: a qualitative study. Int Urogynecol J 32, 387–394 (2021). https://doi.org/10.1007/s00192-020-04431-0
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DOI: https://doi.org/10.1007/s00192-020-04431-0