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Objectives To compare perioperative outcomes of obese vs. non-obese patients undergoing gynecologic surgery on an ERAS program. Methods We retrospectively reviewed patients undergoing open surgery 11/2014–11/2018. Patients were classified into three categories based on body mass index (BMI) and obesity class:: normal/overweight [BMI 18.0–29.9 kg/m2], class I [BMI 30.0–34.9 kg/m2], class II [BMI 35.0–39.9 kg/m2], and class III or greater [BMI ≥40.0 kg/m2]. Obese patients were matched to non-obese patients by age, procedure date, and surgical indication. Standard statistical methods were utilized. Primary outcome was postoperative length of stay [LOS]. Results After matching, 696 patients were included in the analysis [normal/overweight, n=348; class I, n=163 class II, n=88; class III or greater, n=97]. All groups had a median postoperative LOS of 3 days. Obese patients had longer procedure times [median OR time: 218 min vs. 192.5 min, p Conclusions Even after longer operative time and greater blood loss, obese ERAS patients had comparable compliance, perioperative complications, and length of stay to non-obese patients.

Objectives To evaluate differences in hospital charges and healthcare service utilization for gynecologic surgery patients managed before and after ERAS implementation. Methods We retrospectively reviewed women undergoing open gynecologic surgery before and after ERAS implementation. Consecutive patients from 5/2014–10/2014 and 11/2014–11/2015 comprised the pre-ERAS and ERAS cohorts, respectively. Patients were excluded if they had a multidisciplinary surgical team or underwent minimally invasive surgery. All technical and professional charges were ascertained for healthcare services from procedure date until postoperative day 30. Adjuvant treatment charges were excluded. Charges were categorized by the type of clinical service provided. The primary outcome was the difference in total charges between the two groups. Results A total of 271 patients were included with 58 and 213 patients in the pre-ERAS and ERAS cohort, respectively. 70,177 technical charges and 6,775 professional charges were identified and classified. The median hospital charge decreased 15.6% from the pre-ERAS to ERAS groups [95% CI 0–39%; p=0.008]. ERAS patients had lower charges for laboratory services [20% decrease; 95% CI 0–39%; p=0.04], pharmacy services [30% decrease; 95% CI 14–41%; p Conclusions Hospital charges and healthcare service utilization were lower for ERAS patients compared with patients receiving conventional perioperative care. ERAS may be considered high value as it provides improved outcomes while lowering resource utilization.