Multimodal perioperative pain protocol for gynecologic laparotomy is associated with reduced hospital length of stay

Jordan Mattson, MacKenzie Thayer, Sarah L. Mott, Yasmin A. Lyons, Abbey Hardy-Fairbanks, Emily K. Hill

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objectives: The primary objective was to evaluate the impact of a multimodal perioperative pain regimen on length of hospital stay for patients undergoing laparotomy with a gynecologic oncologist. Methods: We compared 52 patients who underwent laparotomy with a gynecologic oncologist at a single institution between 2017 and 2018, after implementation of a multimodal perioperative pain regimen, to a historic cohort of 94 patients (2016–2017). The multimodal pain regimen included pre- and post-operative administration of oral acetaminophen, gabapentin, and celecoxib, in addition to standard narcotics and optional epidural analgesia. Demographic, surgical, and post-operative data were collected. Results: On multivariable analysis, bowel resection, stage, surgery length, age, and cohort group were retained as significant independent predictors of length of stay. Patients undergoing laparotomy prior to the pain protocol had a length of stay 1.26 times longer than patients during the post-implementation period (p < 0.01). For complex surgical patients, this translated into a reduction in length of hospital stay of 1.73 days. There was a significant reduction in pain scale score on post-operative day zero from 5 to 3 (p = 0.02) and a non-significant overall reduction of post-operative morphine equivalents, with similar adverse outcomes. Conclusion: Implementation of a multimodal perioperative pain regimen in patients undergoing gynecologic oncology laparotomy was associated with a significant reduction of length of hospital stay and improved patient-perceived pain, even in the absence of a complete Enhanced Recovery After Surgery (ERAS) protocol.

Original languageEnglish (US)
Pages (from-to)1082-1089
Number of pages8
JournalJournal of Obstetrics and Gynaecology Research
Volume47
Issue number3
DOIs
StatePublished - Mar 2021
Externally publishedYes

Keywords

  • length of stay
  • opiates
  • pain protocol
  • postoperative pain

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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