Introduction Of Major Gynaecology Enhanced Recovery Programme To Reduce Delays To Discharge Due To Pain For Patients Undergoing Hysterectomy Procedures

GASOC International Conference 2025
ABSTRACT FIRST PRESENTED: 24.10.2025

doi: 10.52648/GASOC.1006_350

Introduction Of Major Gynaecology Enhanced Recovery Programme To Reduce Delays To Discharge Due To Pain For Patients Undergoing Hysterectomy Procedures

Henry Somers , V Himanshu, Jeveria Raja, Camilla Smith, Alexandra Scholey, Charlotte Porter-Hope, Ora Jesner
Barts Health NHS Trust, London, United Kingdom; Barts Health NHS Trust,, London, United Kingdom

Introduction: The GIRFT Maternity and Gynaecology National Report identified an opportunity to reduce length of stay (LoS) following hysterectomy to improve bed capacity and reduce costs.

Aims: We introduced the Major Gynae Enhanced Recovery Programme (ERP) based on Enhanced Recovery After Surgery (ERAS) evidence with the aim of standardising and optimising perioperative analgesia prescribing and reducing frequency of delayed discharge due to pain.

Methods: Retrospective baseline analysis across all hysterectomies highlighted large variation in peri-operative analgesia prescribing. The ERP guidelines advocated immediate-release opioids over modified-release formulations, preference for tramadol or morphine over oxycodone (except in renal impairment) and non-opioid multimodal adjuncts. Adherence to ERP guidelines, LoS and delays to discharge were audited in two post-intervention cycles, with deep dive analysis for pain-related delays.

Results: Post-intervention, delayed discharges due to pain for laparoscopic hysterectomies decreased from 24% to 12% and for abdominal hysterectomies decreased from 32% to 25%. No pain-related delays to discharge occurred in robotic or vaginal hysterectomies. Analgesic prescribing aligned with ERP guidelines in 76% of cases; 40% of patients with pain-related delays to discharge did not receive analgesia prescribing as per ERP guidelines.

Conclusion: ERP implementation improved analgesia standardisation and reduced pain-related delayed discharges in laparoscopic hysterectomy and abdominal cases. This project could be easily and economically replicated in resource-constrained setting.

Keywords: Enahnced Recovery, Gynecological Surgery, Hysterectomy

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