{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:21:38Z","timestamp":1789676498976,"version":"4.0.1"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to evaluate the feasibility and safety of planned postoperative day 1 discharge (PPOD1) among patients who undergo laparotomy (XL) in the department of gynecology oncology utilizing a modified enhanced recovery after surgery (ERAS) protocol including opioid-sparing anesthesia (OSA) and defined discharge criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients undergoing XL and minimally invasive surgery (MIS) were enrolled in this prospective, observational cohort study after the departmental implementation of a modified ERAS protocol. The primary outcome was quality of life (QoL) using SF36, PROMIS GI, and ICIQ-FLUTS at baseline and 2- and 6-week postoperative visits. Statistical significance was assessed using the two-tailed Student's <jats:italic>t<\/jats:italic>-test and non-parametric Mann\u2013Whitney two-sample test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 141 subjects, no significant demographic differences were observed between the XL group and the MIS group. The majority of subjects, 84.7% (61), in the XL group had gynecologic malignancy [vs. MIS group; 21 (29.2%), <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001]. All patients tolerated OSA. The XL group required higher intraoperative opioids [7.1\u2009\u00b1\u20099.2 morphine milligram equivalents (MME) vs. 3.9\u2009\u00b1\u20096.9 MME, <jats:italic>p<\/jats:italic>\u2009=\u20090.02] and longer surgical time (114.2\u2009\u00b1\u200941\u2005min vs. 96.8\u2009\u00b1\u200932.1\u2005min, <jats:italic>p<\/jats:italic>\u2009=\u20090.006). No significant difference was noted in the opioid requirements at the immediate postoperative phase and the rest of the postoperative day (POD) 0 or POD 1. In the XL group, 69 patients (73.6%) were successfully discharged home on POD1. There was no increase in the PROMIS score at 2 and 6 weeks compared to the preoperative phase. The readmission rates within 30 days after surgery (XL 4.2% vs. MIS 1.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.62), rates of surgical site infection (XL 0% vs. MIS 2.8%, <jats:italic>p<\/jats:italic>\u2009=\u20090.24), and mean number of post-discharge phone calls (0 vs. 0, <jats:italic>p<\/jats:italic>\u2009=\u20090.41) were comparable between the two groups. Although QoL scores were significantly lower than baseline in four of the nine QoL domains at 2 weeks post-laparotomy, all except physical health recovered by the 6-week time point.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PPOD1 is a safe and feasible strategy for XL performed in the gynecologic oncology department. PPOD1 did not increase opioid requirements, readmission rates compared to MIS, and patient-reported constipation and nausea\/vomiting compared to the preoperative phase.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.1279907","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T09:29:40Z","timestamp":1699003780000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Feasibility and safety of planned early discharge following laparotomy in gynecologic oncology with enhanced recovery protocol including opioid-sparing anesthesia"],"prefix":"10.3389","volume":"10","author":[{"given":"Michelle L.","family":"Kuznicki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Yasukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrianne R.","family":"Mallen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarissa","family":"Lam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Eggers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jefferson","family":"Regis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Wells","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Todd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon E.","family":"Robertson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Tanner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew L.","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Rutherford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.ygyno.2023.04.009","article-title":"Enhanced Recovery After Surgery (ERAS(R)) Society guidelines for gynecologic oncology: addressing implementation challenges\u20142023 update","volume":"173","author":"Nelson","year":"2023","journal-title":"Gynecol Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/AOG.0b013e31829aa780","article-title":"Enhanced recovery in gynecologic surgery","volume":"122","author":"Kalogera","year":"2013","journal-title":"Obstet Gynecol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1097\/AOG.0000000000002735","article-title":"Effect of an enhanced recovery after surgery program on opioid use and patient-reported outcomes","volume":"132","author":"Meyer","year":"2018","journal-title":"Obstet Gynecol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1308\/rcsann.2017.0149","article-title":"Accelerated discharge within 72\u2005h of colorectal cancer resection using simple discharge criteria","volume":"100","author":"Emmanuel","year":"2018","journal-title":"Ann R Coll Surg Engl"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1007\/s12630-022-02336-8","article-title":"Opioid-sparing anesthesia and patient-reported outcomes after open gynecologic surgery: a historical cohort study","volume":"69","author":"Zorrilla-Vaca","year":"2022","journal-title":"Can J Anaesth"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1007\/s00268-012-1634-9","article-title":"A single, global patient-centered measure from the SF-36 instrument to assess surgical outcomes and quality of life: a pilot study","volume":"36","author":"Velanovich","year":"2012","journal-title":"World J Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). 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