Perioperative managment for gynecological surgery in accelerated rehabilitation programme

Abstract

The Enhanced Recovery After Surgery (ERAS), or Fast Track Surgery, aims to minimise the physiological stress of surgery and optimise patient rehabilitation. However, data on surgical interventions in obstetrics and gynaecology are limited. The aim of the study was to analyse the use of elements of the ERAS programme in gynaecologic surgery clinics and to assess the benefits of this approach. Analytical processing was carried out on systematic reviews and meta-analyses, articles and scientific reports published before June 2023, found and available through the PubMed, EMBASE, Cochrane Central Register of Controlled Trials databases. The data were obtained from relevant published studies, including changes in quality of life, postoperative pain, use of opioids or anaesthesia, postoperative nausea and vomiting, rate of readmission, cost of hospitalisation, and clinically significant increase in patient satisfaction. The ERAS programme is a multimodal and multidisciplinary programme aimed at optimising perioperative treatment and improving postoperative outcomes in operative gynaecology by minimising the patient’s stress response, promoting functional recovery and achieving rapid recovery, where the patient is in the field of view of a number of specialists. The presented publications demonstrate that this concept of FTS is a fundamentally new approach to the surgical treatment of gynaecological patients and covers all stages of perioperative therapy: preoperative, intraoperative and postoperative. Conclusions. The initial stage of the surgeon’s and anaesthetist’s acquaintance with the patient is very important, as communication and rational presentation of information using illustrative and video material helps the patient understand the disease, consciously choose the proposed method of treatment, reduces anxiety, increases the role of the surgical team in treatment and satisfaction with its outcome, reduces the risk of dissatisfaction from false expectations (duration of the perioperative period, pain, changes in nutrition and mobility, sutures, etc.). The introduction of evidence-based medicine into the practice of operative gynaecology restructures classical approaches and principles of patient treatment, raises awareness of doctors and heads of surgical departments, and also contributes to the improvement of the outcome of operations.