L. Frigerio

Enhanced Recovery in Gynecologic Surgery and Oncology

Bergamo, 22-23 Maggio 2017

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

Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016

Postoperative hospitalization (min 1 ; max 172)

- Mean : 2,5 days - Median : 2 days

Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016

Post-operative hospitalization Gynecological Surgery

(min 1 ; max 172)

Median : 3 days

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

Bergamo Hospital ASST-PG23: Gynecol & Obstet 2016

Total births 4.235 Vaginal delivery 3.245 Regional anesthesia & analgesia 2.468 (58%)

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

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

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

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

Grazie