8633 ERAS Implementation in Hysterectomy Patients at a Public Hospital during the COVID-19 Pandemic

STUDY OBJECTIVE: Immediately prior to the COVID-19 pandemic, in early 2020, our public hospital implemented an enhanced recovery after surgery (ERAS) protocol. The purpose of this study was to evaluate ERAS outcomes for hysterectomy patients at our public hospital given concerns about barriers to care in our underserved population. DESIGN: A retrospective analysis was performed comparing outcomes (% outpatient cases, length of stay, peri-operative opioids, % ED return) for hysterectomy patients for pre- and post- intervention periods (2019 and 2021). Outcomes were compared using Fisher's exact or t-test. SETTING: A tertiary care public hospital. PATIENTS OR PARTICIPANTS: All patients who underwent hysterectomy in the years 2019 and 2021 at our medical center. INTERVENTIONS: ERAS protocol was implemented in early 2020. MEASUREMENTS AND MAIN RESULTS: 356 pre-intervention and 285 post-intervention hysterectomy cases were analyzed. The majority of patients were Hispanic/Latinx in both groups (80% vs. 78%; p=0.43). There was no significant change in the percentage of minimally invasive procedures (71% vs 68%; p=0.49). The percentage of outpatient hysterectomies increased from 0% to 49% (p<0.0001), and the mean length of stay (LOS) decreased from 1.7 days to 1.1 days (p<0.0001). Peri-operative mean morphine milligram equivalents (MME) decreased from 77 to 60 (p<0.0001). Mean post anesthesia care unit stay increased from 178 to 261 minutes (p<0.0001). There was no increase in returns to the emergency department <30 days (12% vs 9%; p=0.31) or mean number of opioid pills prescribed (12 vs 13; p=0.14). CONCLUSION: ERAS implementation for hysterectomy patients at our public hospital decreased LOS and peri-operative opioids without increasing ED returns. Although there was initial hesitation in adopting the ERAS protocol, these changes proved to be feasible and safe in our underserved patient population. The COVID-19 pandemic likely helped to expedite the integration of outpatient management, which resulted in a decrease utilization of our limited inpatient resources, at a crucial time for our health system.