Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice

Abstract

IntroductionEnhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns.MethodsRequests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods.ResultsData from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 61%, Americas 53%, Asia 30%, and Africa 17%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding.ConclusionThis international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.

Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada

“…5-day reduction in LOS was observed. These findings are in keeping with level I studies 29,30 that supported the role of ERAS in ovarian cancer debulking, despite the fact that a recent survey31 of gynecologic oncologists found low ERAS uptake in cytoreductive surgery.…”

Enhanced recovery after surgery (ERAS) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC): a cross-sectional survey

“…Our study showed that 38% of respondents already have ERAS practices instituted in their protocols. This aligns with a recent international survey among gynecological oncology surgeons [ 21 ]. It was encouraging to see that most (91%) other institutes were following some of the ERAS practices, more importantly, as no formal ERAS CRS-HIPEC guidelines were available at the time of this study.…”

“…This adds value to this study since they form one of the ‘ERAS champions’ along with surgeons and nurses [ 18 ]. Similar surveys in past [ 19 ], [ 20 ], [ 21 ] had invited only surgeons to respond. ERAS practices are gradually being incorporated as institutional protocols.…”

Implementing Enhanced Recovery after Surgery in Obstetrics: A Lesson from the Nationwide Lockdown

“…11 The literature review showed that most of the studies originated and propagated in an ideal setting in developed countries. 12 Few studies were carried out in public hospitals in the sub-Saharan and our South Asian region. The RCT using modified yet comprehensive ERAS conducted in Uganda showed favorable outcomes in terms of early discharge and rates of postoperative complications.…”