Adoption of enhanced recovery after laparotomy in gynecologic oncology

Abstract

IntroductionEnhanced recovery after surgery (ERAS) pathways combine a comprehensive set of peri-operative practices that have been demonstrated to hasten patient post-operative recovery. We aimed to evaluate the adoption of ERAS components and assess attitudes towards ERAS among gynecologic oncologists.MethodsWe developed and administered a cross-sectional survey of attending, fellow, and resident physicians who were members of the Society of Gynecologic Oncology in January 2018. The χ2 test was used to compare adherence to individual components of ERAS.ResultsThere was a 23% survey response rate and we analyzed 289 responses: 79% were attending physicians, 57% were from academic institutions, and 64% were from institutions with an established ERAS pathway. Respondents from ERAS institutions were significantly more likely to adhere to recommendations regarding pre-operative fasting for liquids (ERAS 51%, non-ERAS 28%; p<0.001), carbohydrate loading (63% vs 16%; p<0.001), intra-operative fluid management (78% vs 32%; p<0.001), and extended duration of deep vein thrombosis prophylaxis for malignancy (69% vs 55%; p=0.003). We found no difference in the use of mechanical bowel preparation, use of peritoneal drainage, or use of nasogastric tubes between ERAS and non-ERAS institutions. Nearly all respondents (92%) felt that ERAS pathways were safe.DiscussionPracticing at an institution with an ERAS pathway increased adoption of many ERAS elements; however, adherence to certain guidelines remains highly variable. Use of bowel preparation, nasogastric tubes, and peritoneal drainage catheters remain common. Future work should identify barriers to the implementation of ERAS and its components.

Risk factors of deep vein thrombosis of lower extremity in patients undergone gynecological laparoscopic surgery: what should we care

“…At present, there are large differences in reports on the incidence of DVT after gynecological diseases. The incidence of DVT after gynecological surgery ranges from 11 to 29% [1,10]. Sakon et al [11] have pointed out that DVT occurred after gynecological surgery, the incidence of DVT can be as high as 17.5%.…”

“…In recent years, with the continuous improvement of surgical technology and the improvement of surgical instruments and equipment, deep vein thrombosis (DVT) of the lower extremities is still one of the common complications after gynecological surgery [1]. The feared complication of DVT is pulmonary embolism, which is closely associated with higher mortality and poorer prognosis [2].…”

Level of Understanding of Eras Affects Practitioners’ Practice and Perception of Early Postoperative Resumption of Oral Intake: A Nationwide Survey

“…On the other hand, despite the clinical bene ts of early resumption of oral intake, its implementation in clinical practice has been relatively "delayed". Possible reasons include a lack of convincing data, a lowlevel understanding of ERAS, and limitations in institutional experience and systems (19). Therefore, in an effort to identify di culties in the implementation of early postoperative oral intake programs, we carried out a nationwide survey to determine clinical practices and attitudes toward the postoperative resumption of oral intake among all clinical practitioners along with their level of understanding of ERAS.…”

Thirty‐day outcomes after gynecologic oncology surgery: A single‐center experience of enhanced recovery after surgery pathways

“…Since then, 27 guidelines have been developed for different clinical scenarios using the principles of physiological homeostasis, 4 and have been associated with improved outcomes in other surgical specialities, such as urologic, thoracic and orthopedic surgery 5‐8 . The first gynecologic oncology guidelines were published in 2016 9 and revised in 2019 10 ; they consist of 16 elements and have been purportedly adopted across North America 11 . Practice surveys from Europe, America and Australia/New Zealand have however shown that while certain elements of the ERAS pathways such as antibiotic prophylaxis and hypothermia prevention are now standard of care within the gynecologic oncology community, others, such as shortened fasting times, avoidance of nasogastric tubes or carbohydrate loading, have not been widely adopted 11‐13 …”

“…[5][6][7][8] The first gynecologic oncology guidelines were published in 2016 9 and revised in 2019 10 ; they consist of 16 elements and have been purportedly adopted across North America. 11 Practice surveys from Europe, America and Australia/New Zealand have however shown that while certain elements of the ERAS pathways such as antibiotic prophylaxis and hypothermia prevention are now standard of care within the gynecologic oncology community, others, such as shortened fasting times, avoidance of nasogastric tubes or carbohydrate loading, have not been widely adopted. [11][12][13] In keeping with the provincial call for implementation of a…”