enhanced recovery in gynecologic surgery and oncology · no randomized controlled trial available...
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L. Frigerio
Enhanced Recovery in Gynecologic Surgery and Oncology
Bergamo, 22-23 Maggio 2017
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Papa Giovanni XXIII Hospital Bergamo 2016
• 1.200 beds with high specialization and technology
• 700 Medical Doctors with interdisciplinary skills
• 43.000 Admissions procedures
• 39.000 Surgical procedures
• 106 Gynecologic & Obstetric beds
• 4.235 Number of births
• 4.401 Ob & Gyn Surgical procedures
• 315 Transplants
Bergamo, 2017
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Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016
Postoperative hospitalization (min 1 ; max 172)
- Mean : 2,5 days - Median : 2 days
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Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016
Post-operative hospitalization Gynecological Surgery
(min 1 ; max 172)
Median : 3 days
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Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016
Total births : n 4235 Caesarean n =990 (23%) Natural n = 2345
Natural 77%
[NOME CATEGORI
A] [PERCENTUA
LE]
Bergamo, 2017
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Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016
Total births 4.235 Vaginal delivery 3.245 Regional anesthesia & analgesia 2.468 (58%)
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Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016
Spinal Anesthesia (99% of cases) Analegesic therapy (Paracetamol 1 gr iv)
Removal of Bladder catheter 6 hours after
Mobilization & Liquid Diet at day 0
Solid food on day 1
Management Protocol for Caesarean Birth
Bergamo, 2017
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Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016
Days of hospitalization (min 2 ; max 69) Median 4 days Median 3 days Discharge after surgery
Admission one day before caesarean section for fetal monitoring
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ENHANCED RECOVERY AFTER SURGERY
Yoong W, Sivashanmugarajan V, Relph S, et al. Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study. J Minim Invasive Gynecol. 2014;21:83–9. Verheijen PM, Vd Ven AW, Davids PH, Vd Wall BJ, Pronk A. Feasibility of enhanced recovery programme in various patient groups. Int J Colorectal Dis. 2012;27:507–11
Lu D. Perioperative enhanced recovery programmes for gynaecological cancer patients. Cochrane Database Syst Rev. 2015;3:CD008239
Gynecological surgery has
changed
Laparoscopic and robotic
surgery has improved the results
We can work to improve our
patients' care pathways
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ENHANCED RECOVERY AFTER SURGERY
Effective in elective general surgery
Used in gynaecological surgery
No randomized controlled trial available
Yoong W, Sivashanmugarajan V, Relph S, et al. Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study. J Minim Invasive Gynecol. 2014;21:83–9. Verheijen PM, Vd Ven AW, Davids PH, Vd Wall BJ, Pronk A. Feasibility of enhanced recovery programme in various patient groups. Int J Colorectal Dis. 2012;27:507–11
Lu D. Perioperative enhanced recovery programmes for gynaecological cancer patients. Cochrane Database Syst Rev. 2015;3:CD008239
Bergamo, 2017
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Grazie