Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery

Chapman, Jocelyn; Roddy, Erika; Ueda, Stefanie; Brooks, Rebecca; Chen, Lee‐lynn; Chen, Lee-may

doi:10.1097/aog.0000000000001466

Cited by 91 publications

(68 citation statements)

References 14 publications

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“…However, same day discharge is achievable for many patients undergoing gynecologic minimally invasive surgery procedures, regardless of whether or not the procedures were performed on a formal ERAS pathway 148. Retrospective comparative studies suggest that ERAS implementation in minimally invasive surgery demonstrated an association with improvements in length of stay and cost 149. Another series described an association of ERAS implementation with decreased intraoperative and post-operative morphine equivalents, decreased cost, and with increased patient satisfaction 144.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

International Journal of Gynecological Cancer

537

364

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BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

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Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

International Journal of Gynecological Cancer

537

364

View full text Add to dashboard Cite

show abstract

“…Then a number of prospective cohort studies with the concept "fast track", later called ERAS, were published all showing short hospital stay, one day for laparoscopic hysterectomy and two days for abdominal hysterectomy (Moller, et al 2001), and a reduction of two hospital days with fewer complications for ovarian cancer patients (Marx, et al 2006, Carter 2012. More trials followed with ERAS in gynaecology covering benign and oncological surgery (Chapman, et al 2016, de Groot, et al 2016, Kalogera and Dowdy 2016. An ERAS programme consists of several parts and includes preoperative education of the patient that provides clear information concerning pre-, peri-and post-operative care, use of safe and short-acting anaesthetics, use of minimally invasive surgery when feasible, optimisation of postoperative pain relief comprising use of local and regional anaesthetic (spinal anaesthesia with intrathecal morphine or epidural anaesthesia), minimal use of opioids, optimal nausea treatment, early start of enteral nutrition, early ambulation, and balanced perioperative fluid regulation (Nelson, et al 2016a, Nelson, et al 2016b.…”

Section: Perioperative Care and Erasmentioning

confidence: 99%

On Quality Improvement in Gynaecological Cancer Surgery

Lundin

2020

Linköping University Medical Dissertations

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Objectives: The overall purpose of this thesis was to find medical and surgical treatment methods of improving the perioperative care of gynaecological cancer patients. The specific objectives were to determine whether a single dose tranexamic acid given immediately before surgery for presumed advanced ovarian cancer reduces perioperative blood loss and the need for blood transfusions, and to determine whether postoperative recovery, tissue damage, and inflammatory response markers differ between women operated with robotic and abdominal hysterectomy for low-risk endometrial cancer in an enhanced recovery after surgery (ERAS) programme, and to evaluate costs for hospital stay and postoperative recovery in relation to health impact. Material and Methods: The thesis was based on two randomised trials. The first trial was a randomised double-blind placebo-controlled multicentre study conducted in four hospitals in the southeast and central of Sweden between March 2008 and May 2012. One hundred women with presumed advanced ovarian cancer who had been scheduled for radical debulking surgery were included; 50 received tranexamic acid and 50 received a placebo. The main outcomes were blood loss and red blood cell transfusions. The second trial was a randomised open single centre trial at a Swedish university hospital, which included 50 women with low-risk endometrial cancer scheduled for radical surgery between February 2012 and May 2016; 25 women underwent robotic hysterectomy and 25 had abdominal hysterectomy. Anaesthesia and perioperative care followed an ERAS protocol in both groups. The EuroQol Group form EQ-5D-3L and the Short Form-36 evaluated the health-related quality of life. The Swedish Postoperative Symptoms Questionnaire assessed symptoms perioperatively until six weeks postoperatively. Venous blood samples were collected on several occasions until six weeks postoperatively and were analysed for markers reflecting inflammatory response and tissue damage. In addition, a health-economy analysis was conducted comparing total costs, quality-adjusted life years (QALYs) and cost per QALY between the surgical methods. Results: Total blood loss volume and transfusion rate following surgery in advanced ovarian cancer were significantly lower in the tranexamic group compared with the placebo group. Women with early endometrial cancer treated by robotic hysterectomy recovered significantly faster in the EQ-5D health index, and reached their preoperative level nearly two weeks earlier than the abdominal group. Differences regarding improvement in health-related quality of life (Short Form-36) comprising general health and social functioning were more favourable in the robotic hysterectomy group. Consumption of analgesics, pain intensity, postoperative symptom sum score and length of hospital stay were equal between the groups. The occurrence of complications was an independent risk factor and influenced most of the outcome measures adversely. Postoperative inflammatory response and tissue damage were lower after roboti...

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“…ERAS initiatives refer to a post-surgical pathway which aims to expedite return to the normal physiological state, improving patient outcomes and shortening LoS 2 3. ERAS programmes have become increasingly popular for elective surgery in a range of surgical specialties, including gynaecology 4–7. However, implementation in obstetrics has been slower despite increasing numbers of caesarean sections performed every year in the UK.…”

Section: Problemmentioning

confidence: 99%

Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge

et al. 2019

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Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a ‘fast-track pathway’ (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions.

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Enhanced Recovery Pathways for Improving Outcomes After Minimally Invasive Gynecologic Oncology Surgery

Abstract: An enhanced recovery pathway in patients undergoing gynecologic oncology minimally invasive surgery is associated with significant improvements in recovery time, decreased pain despite reduced opioid use, and overall lower hospital costs.

Cited by 91 publications

References 14 publications

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

On Quality Improvement in Gynaecological Cancer Surgery

Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge

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