Effects of an enhanced recovery after surgery (ERAS) program in elder patients undergoing transvaginal reconstructive surgery for pelvic organ prolapse (POP): a multicenter randomized parallel open-label controlled trial.

Abstract

<h4>Purpose</h4>To develop a locally tailored ERAS program for 60-80-year-old patients with pelvic organ prolapse (POP) undergoing transvaginal mesh (TVM) surgery in low- and middle-resource countries.<h4>Methods</h4>In this multicenter randomized controlled trial conducted at seven tertiary hospitals, 262 women aged 60-80 scheduled for elective TVM surgery were randomly allocated (1:1) to receive either a comprehensive ERAS perioperative intervention or conventional perioperative management (131 participants per group). The primary outcomes were postoperative length of stay, pain scores, time to first flatus, removal of urinary catheter, first assisted walking, postoperative complications, readmission, emergency visit, in-hospital costs, PGI-I, QoR-15, PONV, and residual urine volume.<h4>Results</h4>ERAS group had significantly shorter postoperative length of stay (median 3.92 days vs. 4.99 days, HR = 1.42, 95% CI 1.11-1.82, P = 0.005), lower pain scores within 24 h, faster time to first flatus, removal of urinary catheter, and first assisted walking. There were no significant differences between the ERAS and conventional groups regarding postoperative complications, readmission, emergency visit, in-hospital costs, PGI-I, QoR-15, PONV, and residual urine volume. There was no 30-day postoperative readmission in both groups.<h4>Conclusions</h4>ERAS program can reduce length of stay and improve postoperative outcomes in patients undergoing vaginal reconstructive surgery. Recommend implementing ERAS for 60-80-year-olds in East Asia where TVM surgeries are still an option for POP.<h4>Clinical registration</h4>ChiCTR2200057422 (March 12, 2022).