UPMC Video Rounds - Urogynecology ERAS Pathways

December 4, 2019

 

Halina Zyczynski, MD, division director, Urogynecology and Pelvic Reconstructive Surgery: 

The ERAS Pathway, and our global gender targeted approach to the surgical experience at UPMC has resulted in just a tremendous paradigm shift. Our patients are now going home 92 percent of the time. So, we've gone from 26 percent same day discharge rate to 92 percent. That's overall. 25 percent of our surgical patients are over the age of 75 years. And as such, we felt that we needed to, it was our responsibility, to take the needs of that oldest, but substantial population into consideration when we designed our ERAS Pathways.

We have adopted a multimodal pain management strategy that relies on everything from acetaminophen, or Tylenol, through non-steroidals to reduce inflammation in the surgical environment. And a very small amount of an extended release oral morphine pill that is in the system for the many hours that the patient is with us in the hospital and entering anesthesia.

The central tenants of the ERAS Pathways, or principles, include patient selection, the medical optimization of patients, establishing expectations of what surgery will be like. For us, very much learning about and taking into consideration the social support system of the patient because we are returning her to that environment, and we wanna make sure that she will be safe. It's not until you custom design an experience for the older population, that you can expect to them as well, if not better, than their counterparts who are 20, 30 years younger.

 

Learn more about gynecology at UPMC Magee-Womens Hospital.