ERAS Preoperative Counseling for Post-Surgical Recovery in Gynecology

Overseen By Patricia S Huguelet, MD

Age: < 18

Sex: Female

Trial Phase: Academic

Sponsor: University of Colorado, Denver

Disqualifiers: Developmental delay, Emergency surgery, others

Compensation: Varies

Number of Visits: 1

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether involving both patients and their caregivers in pre-surgery counseling can help children and teens manage pain more effectively after gynecological surgery. The counseling is part of the Enhanced Recovery After Surgery (ERAS) program, which aims to speed up recovery. Participants will either receive counseling with their caregiver or have only their caregiver attend the session. Children aged 9 to 17 scheduled for abdominal surgery and following the ERAS protocol might be suitable candidates, especially if they regularly attend medical appointments with a caregiver. As an unphased trial, this study provides a unique opportunity to contribute to research that could enhance recovery experiences for young patients.

Do I need to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It focuses on pre-operative counseling and compliance with ERAS-prescribed medications.

What prior data suggests that this counseling protocol is safe for post-surgical recovery in gynecology?

Research has shown that Enhanced Recovery After Surgery (ERAS) programs are both helpful and safe. Studies indicate that ERAS protocols enable quicker recovery after surgery, with fewer complications and shorter hospital stays. As a result, ERAS counseling, whether for caregivers or patients, is generally well-received.

The ERAS guidelines aim to improve patient recovery and well-being by maintaining normalcy during the surgical process. This approach reduces the risk of post-surgery complications.

No specific reports of serious side effects from ERAS counseling itself have emerged. It primarily involves providing education and advice on preparing for and recovering from surgery, making it a safe component of the overall ERAS program. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial exploring Enhanced Recovery After Surgery (ERAS) counseling because it aims to improve post-surgical recovery in gynecology through a unique approach. Unlike traditional methods that only involve patients, this trial compares the impact of including caregivers in the pre-operative counseling process. By engaging caregivers, researchers hope to enhance the support system for patients, potentially leading to faster recovery times and improved outcomes. This approach could offer a new dimension to patient care by empowering both patients and their support networks, which is not typically emphasized in standard surgical recovery protocols.

What evidence suggests that ERAS counseling is effective for post-surgical recovery in gynecology?

Research shows that the Enhanced Recovery After Surgery (ERAS) program can help patients recover faster after gynecologic surgeries. Studies have found that following ERAS guidelines shortens hospital stays and reduces the risk of complications. In this trial, participants will receive either pre-operative counseling with their caregiver or caregiver-only counseling. ERAS methods have also led to better outcomes for patients undergoing both non-cancerous and cancer-related gynecologic surgeries. Overall, the ERAS approach, which includes counseling and other strategies, speeds up recovery and lowers the chance of post-surgery problems. ^{2 3 6 7 8}

Who Is on the Research Team?

Patricia Huguelet, MD

Principal Investigator

University of Colorado, Denver

Are You a Good Fit for This Trial?

This trial is for young individuals aged 9-17 who are scheduled for abdominal surgery under the ERAS protocol. They must be accompanied by a caregiver to clinic appointments and not have an emergency or non-elective surgical case. Those with developmental delays (IQ < 70) are excluded.

Inclusion Criteria

I am between 9 and 17 years old.

I am having abdominal surgery and will follow the ERAS recovery plan.

Exclusion Criteria

I require surgery urgently or unexpectedly.

Developmental delay (IQ < 70) determined by documentation in medical record

I go to my clinic appointments without needing someone to take me.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Pre-operative Counseling

Participants receive pre-operative counseling with either their caregiver or caregiver-only to improve post-surgical outcomes

1 day

1 visit (in-person)

Post-operative Monitoring

Participants are monitored for pain scores, medication adherence, and return to school

1-7 days

Follow-up via chart review and patient report

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Enhanced Recovery After Surgery (ERAS) Counseling to Caregiver
• Enhanced Recovery After Surgery (ERAS) Counseling to Patients

Trial Overview The study is testing if involving patients in pre-operative counseling alongside their caregivers, as opposed to just the caregivers, improves post-surgical pain management, adherence to prescribed medications, and quicker return to school activities.

How Is the Trial Designed?

Group I: pre-operative counseling with their caregiver Active Control 1 Intervention

Patients will be asked to attend a standard-of-care pre-operative teaching session with their parent.

Group II: caregiver-only counseling. Placebo Group 1 Intervention

Parents-only will attend a standard-of-care pre-operative teaching session.

Who Is Running the Clinical Trial?

University of Colorado, Denver

Lead Sponsor

Trials

1,842

Recruited

3,028,000+

Published Research Related to This Trial

The Enhanced Recovery After Surgery (ERAS) protocol significantly reduces the length of hospital stay and improves recovery times, such as time to ambulation and bowel function, in 104 patients undergoing minor gynecological surgeries.

Patients following the ERAS protocol required less intravenous fluid and experienced no increase in postoperative complications compared to those receiving conventional care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of enhanced recovery protocol with conventional care in patients undergoing minor gynecologic surgery. Yilmaz, G., Akca, A., Kiyak, H., et al.[2022]

The implementation of the Enhanced Recovery After Surgery (ERAS) protocol in 133 women undergoing elective laparotomy led to significantly lower opioid use during and after surgery, compared to a historical cohort of 121 women, indicating a potential for reduced reliance on pain medications.

Patients following the ERAS protocol reported lower pain scores in the post-anesthesia care unit and on the first postoperative day, suggesting improved pain management, while there were no significant changes in hospital stay length or complication rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reduction in opioid use and postoperative pain scores after elective laparotomy with implementation of enhanced recovery after surgery protocol on a gynecologic oncology service. Schwartz, AR., Lim, S., Broadwater, G., et al.[2020]

The updated ERAS Society guidelines provide a comprehensive consensus on optimal perioperative care specifically for gynecologic and oncology surgeries, based on a thorough review of the latest evidence from meta-analyses, randomized controlled trials, and large cohort studies.

All recommendations within the ERAS protocol are grounded in the best available evidence, ensuring that the guidelines reflect the most effective practices for improving patient outcomes in these surgical procedures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Nelson, G., Bakkum-Gamez, J., Kalogera, E., et al.[2020]

In a pilot study of 50 patients undergoing elective gynecologic surgeries, the surgical team showed excellent compliance with ERAS guidelines, particularly in preoperative counseling (94%) and intraoperative management (86%).

However, areas needing improvement included preoperative fasting duration, prehabilitation, and early postoperative feeding, indicating that while the team is largely compliant, there are specific practices that could enhance patient recovery further.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

ERAS: An Audit of Existing Practices. Bassetty, KC., Thomas, DS., Sebastian, A., et al.[2023]

In a study of 446 women undergoing gynecologic oncology surgery, achieving over 70% compliance with Enhanced Recovery After Surgery (ERAS) guidelines was linked to significantly lower overall complication rates and shorter hospital stays.

The only independent risk factor for complications identified was intra-operative blood loss greater than 200 mL, highlighting the importance of managing surgical techniques alongside adherence to ERAS protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance? Pache, B., Jurt, J., Grass, F., et al.[2019]

The updated ERAS® Society guidelines provide a consensus on optimal perioperative care for gynecologic oncology surgery, addressing specific implementation challenges to improve adherence to Enhanced Recovery After Surgery (ERAS) protocols.

The recommendations are based on the best available evidence from recent studies, including meta-analyses and randomized controlled trials, ensuring that they are grounded in high-quality research to enhance patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update. Nelson, G., Fotopoulou, C., Taylor, J., et al.[2023]

The ERAS protocol implemented in gynecological surgery showed no significant difference in length of stay (LOS) between patients undergoing hysterectomy for malignant (2 days) versus benign (2 days) conditions, indicating its effectiveness for both groups.

Patients with malignant and benign conditions had similar rates of complications, reoperations, and readmissions, suggesting that the ERAS protocol is safe and beneficial for enhancing recovery regardless of the nature of the disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease. Wijk, L., Franzén, K., Ljungqvist, O., et al.[2018]

The implementation of a pediatric Enhanced Recovery After Surgery (ERAS) protocol for reverse stoma surgery significantly reduced the length of hospital stay from an average of 8.64 days to 6.08 days, indicating improved recovery times.

Patients in the ERAS group experienced faster recovery milestones, such as a decrease in time to oral fluid intake from 4.36 days to 1 day and time to regular diet from 6.14 days to 3.23 days, demonstrating the protocol's efficacy in enhancing postoperative recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Introducing enhanced recovery after surgery protocol in pediatric surgery. Modrzyk, A., Pasierbek, MJ., Korlacki, W., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12174707/

Outcomes of Enhanced Recovery After Surgery (ERAS) ... The study demonstrates that implementing an ERAS protocol in major gynecologic surgery leads to faster recovery, reduced postoperative complications, and ...

2. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2820097

Enhanced Recovery After Surgery Guidelines and Hospital ... Conclusions and Relevance In this meta-analysis, ERAS guidelines were associated with decreased hospital length of stay and complications.

3. sciencedirect.com sciencedirect.com/science/article/pii/S2352578924001899

Enhanced recovery after surgery (ERAS) guided ... Enhanced recovery after surgery (ERAS) pathways have demonstrated improvements in outcomes following benign gynecologic and gynecologic oncology surgery.

4. acog.org acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/09/perioperative-pathways-enhanced-recovery-after-surgery

Perioperative Pathways: Enhanced Recovery After Surgery Enhanced Recovery After Surgery is a comprehensive program, and data demonstrate success when multiple components of the ERAS pathway are implemented together.

5. ajog.org ajog.org/article/S0002-9378(20)30822-X/fulltext

Level I evidence establishes enhanced recovery after ... ERAS has been shown to result in statistically significant improvements in clinical outcomes such as reduction in hospital length of stay (LOS) and ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10316925/

Enhanced Recovery After Surgery (ERAS): New Concepts ... The main objectives of the ERAS program are to accelerate functional recovery, improve postoperative outcomes, shorten the length of stay (LOS) in the hospital.

7. gynecologiconcology-online.net gynecologiconcology-online.net/article/S0090-8258(23)00180-4/fulltext

Enhanced recovery after surgery (ERAS®) society ... This guideline update summarizes evidence investigating ERAS implementation challenges highlighted by stakeholder groups.

8. sasgog.org sasgog.org/established-programs-and-databases/enhanced-recovery-after-surgery-eras/

Enhanced recovery after surgery (ERAS) Enhanced recovery after surgery (ERAS) protocols aim to maintain normal physiology for surgical patients and are widely credited with improving historic ...