COVID-19 pandemic facilitate the adoption of Enhanced Recovery After Surgery in a public hospital in Korea (332)

Objectives: Despite an increasing number of reports on the adoption of the enhanced recovery after surgery program (ERAS) in gynecology in Western countries, there are very few reports on this topic in Korea. Distinct characteristics for infrastructure and insurance systems may attribute to the slow adoption of ERAS. The COVID-19 pandemic forced rearrangement of medical resources, especially in public hospitals dealing with the disease in the frontline. This study aimed to investigate how a public hospital deals with gynecologic surgeries in the circumstances of limited resources caused by the pandemic. Methods: As the COVID-19 developed as a pandemic, the Seoul Metropolitan Government Boramae Medical Center hospital evacuated several wards to admit patients severely suffering COVID-19 since March 2020. The bed count assigned for the obstetrics and gynecology (OBGY) department was forced to decrease from 28 beds to 16 beds (-42%). The availability of outpatient clinics and the surgical facility was not affected. In order to maintain surgical volume, we promptly adopted ERAS in the whole OBGY surgery. Early feeding and individualized discharge planning were applied for all inpatient surgical cases to cope with reduced inpatient volume. The number of surgeries and average hospital stay were compared before and after inpatient volume reduction. Results: There was a slight decrease in the number of total surgeries due to the reduction of Cesarean section cases (1335 in 2018, 1331 in 2019, 1279 in 2020). However, the number of surgeries for benign and malignant gynecologic diseases was not reduced (771 and 94 in 2019, 737 and 94 in 2020, respectively). The proportion of minimally invasive hysterectomy for benign diseases increased (58.8% in 2019, 72.2% in 2020, p=0.03). Single site laparoscopic surgery for the benign adnexal disease increased (40.8% in 2019, 56.1% in 2020, p<0.001). The hospital stay for cesarean section, abdominal hysterectomy, laparoscopic hysterectomy, oncologic staging surgery, laparoscopic adnexal surgery significantly decreased with an average difference of one day. The 90-days re-admission rate was not different between 2019 and 2020. Conclusions: COVID-19 pandemic-related medical resource shortage accelerated adaptation of ERAS in OBGY surgery. Repositioning the medical resources more efficiently is imperative as the COVID-19 pandemic gain momentum.