Z Geburtshilfe Neonatol 2021; 225(S 01): e23
DOI: 10.1055/s-0041-1739761
Abstracts | DGPM

Enhanced Recovery After Surgery (ERAS) in in utero repair of spina bifida

N Ochsenbein-Kölble
1   University Hospital of Zurich, Department of Obstetrics, Zurich, Schweiz
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
,
L Vonzun
1   University Hospital of Zurich, Department of Obstetrics, Zurich, Schweiz
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
,
F Krähenmann
1   University Hospital of Zurich, Department of Obstetrics, Zurich, Schweiz
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
,
N Strübing
1   University Hospital of Zurich, Department of Obstetrics, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
,
M Hüsler
1   University Hospital of Zurich, Department of Obstetrics, Zurich, Schweiz
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
,
R Zimmermann
1   University Hospital of Zurich, Department of Obstetrics, Zurich, Schweiz
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
,
L Kandler
2   University of Zurich, Zurich, Schweiz
4   University Hospital Zurich, Institute of Anesthesiology, Zurich, Schweiz
,
M Meuli
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
5   University Children’s Hospital Zurich, Department of Pediatric Surgery, Zurich, Schweiz
,
L Mazzone
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
5   University Children’s Hospital Zurich, Department of Pediatric Surgery, Zurich, Schweiz
,
U Möhrlen
2   University of Zurich, Zurich, Schweiz
3   Zurich Center for Fetal Diagnosis and Therapy, Zurich, Schweiz
5   University Children’s Hospital Zurich, Department of Pediatric Surgery, Zurich, Schweiz
› Author Affiliations
 

Objective Generally, Enhanced Recovery After Surgery (ERAS) encompasses a multidisciplinary attempt to improve care of patients undergoing surgery. The aim of this study was to assess the effects of a new ERAS protocol on clinical outcomes for women undergoing open fetal spina bifida (SB) repair.

Methods A retrospective non-randomized cohort study was performed including 111 fetal SB cases repaired in utero between 2010–2019. Our new ERAS protocol included a longitudinal and not transverse incision of the maternal fascia without transection of the rectus abdominis muscles and Targin®, a combination of oxycodon and naloxon, as first line pain medication instead of tramadol. Women treated with the old protocol (N=82) were compared to women treated with the new ERAS protocol (N=29). The primary endpoint was the length of hospitalization. Secondary endpoints were postoperative pain scores, day of first mobilization, removal of urinary catheter and first bowel movement, and severe maternal and fetal complications. A t-test, Mann-Whitney U test or chi-square test were used as appropriate. Data is presented as mean±standard deviation. A p-value<0.05 was accepted as significant.

Results Both groups were similar in baseline characteristics. Length of stay was significant shorter with the new ERAS protocol (23±16 vs. 33±20 days; p=0,002). Postoperative pain scores were comparable in both groups. First mobilization and removal of urinary catheter were possible significantly earlier with the new ERAS protocol (2.8±0.6 vs. 3.2±1; p=0,03 and 3.3±1 vs. 3.8±1 days, p=0,004). First bowel movements were similar in both groups (3.7±1.3 vs. 3.5±1.1; p=0.15). No differences in severe maternal and fetal complications were found between both groups.

Conclusion Our new ERAS protocol reduced the length of stay and optimized maternal recovery without compromising maternal or fetal safety.



Publication History

Article published online:
26 November 2021

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