ERAS in Minimally Invasive Gynecology: A Meta-Analysis of the Literature

Abstract

EED) were searched. The search terms "enhanced recovery," "ERAS," "gynecology," "gynecologic surgery," "fast track" were utilized in the search. There were no restrictions regarding the type of study design. English language requirement was placed. In addition, reference lists of the review articles and included studies were reviewed and additional studies of interest were included. Results of all the searches were combined and duplicates removed. Review articles were excluded from analysis. Measurements/Results: The most consistent items included in an ERAS protocol included preoperative patient education and counseling, avoidance of drains/packing, limiting IV fluids intraoperatively, local anesthetic/blocks, multimodal pain management that minimizes narcotic use, and early mobility and feeding. There was a cost savings in the ERAS group for laparoscopic and vaginal surgery but the margin appeared to be dependent on the length of stay of the pre-ERAS groups. There was up to a 80% less narcotic used in the ERAS group but not necessarily a lower pain score. Patient satisfaction scores are high in the ERAS group. Conclusions: The value of ERAS has yet to fully be determined, especially with laparoscopic and vaginal surgery. This is a meta-analysis that is focused on the role of ERAS in minimally invasive gynecology.