Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update

Nelson, Gregg; Fotopoulou, Christina; Taylor, Jolyn; Glaser, Gretchen; Bakkum-Gamez, Jamie N.; Stone, Rebecca L.; Mena, Gabriel E.; Elias, Kevin M.; Altman, Alon D.; Bisch, Steven; Ramírez, Pedro T.; Dowdy, Sean C.

doi:10.1016/j.ygyno.2023.04.009

Cited by 44 publications

(41 citation statements)

References 127 publications

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“…The RANCOG and the Surgical Antibiotic Prophylaxis Guideline at the Women’s in Parkville and in Sandringham suggest the addition of metronidazole to cefazolin as antibiotic prophylaxis prior to hysterectomy [ 12 , 13 ]. Moreover, the use of cefazolin can be replaced by an aminopenicillin with a β lactamase inhibitor, such as amoxicillin–clavulanic acid, as stated by the SEIMC and the Enhanced Recovery After Surgery (ERAS) protocol [ 14 , 15 ]. Finally, according to other guidelines, antibiotic prophylaxis should be differentiated depending on the type of hysterectomy.…”

Section: Resultsmentioning

confidence: 99%

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Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Petousis,

Angelou,

Almperis

et al. 2024

JPM

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Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative space. As common healthcare-associated infections, SSIs correlate with prolonged hospital stay, additional procedures, ICU stay, and higher mortality rates. Around 8–10% of gynecologic surgery patients may experience infectious complications, influenced by microbial contamination, surgical nature, and patient factors. The goal of this narrative review is to compare and merge recommendations from globally published guidelines concerning the utilization of antibiotics in the perioperative phase. A comparative descriptive/narrative review of the guidelines issued by the American College of Obstetrics and Gynecology (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), Royal College of Obstetricians and Gynecologists (RCOG), National Institute for Health and Care Excellence (NICE), Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), European Society of Gynecologic Oncology (ESGO), Société Française d’ Anésthesie et de Réanimation (SFAR), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and Hellenic Society of Obstetrics and Gynecology (HSOG) was conducted. For hysterectomy, first/second-generation cephalosporins are suggested, with metronidazole as an option. Laparoscopy without entering the bowel or vagina typically does not require prophylaxis. Uterine evacuation and hysteroscopy may involve doxycycline or azithromycin based on risk factors, whereas, for vulvectomy, cefazolin is recommended. Urogynecology procedures may include cefazolin with metronidazole. In cases of penicillin allergy, cephalosporins are suggested, and, for obese patients, adjusted doses are advised. Additional doses may be needed for prolonged procedures or excessive blood loss. Timing recommendations are 15–60 min before incision, adjusting for specific antibiotics. Clear indications exist for certain surgeries like hysterectomy, termination of pregnancy, and urogynecologic procedures. Conversely, procedures such as intrauterine device insertion, hysteroscopy, and laparoscopy typically do not necessitate antibiotic prophylaxis. For several other procedures, the evidence is inconclusive, while considering dose, timing, and indications can mitigate infectious complications and provide benefits for the healthcare system.

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Section: Resultsmentioning

confidence: 99%

“…Laparoscopy without entry into the bowel or vagina is considered to be a clean procedure. There is a consensus among all the guidelines that antibiotic prophylaxis is not recommended [ 8 , 9 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Section: Resultsmentioning

confidence: 99%

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Petousis,

Angelou,

Almperis

et al. 2024

JPM

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“…Therefore, providers should really investigate the reaction prior to determining that a cephalosporin cannot be administered. 32,33 Second, often in practice the use of a particular medication has evidence for one indication, but not in another potentially similar use. Many medications listed in ERAS ® guidelines do not have an approved indication in medication labeling for use in various jurisdictions, such as prevention of PONV or SSI.…”

Section: Discussionmentioning

confidence: 99%

“…These guidelines strongly support the utilization of structurally dissimilar cephalosporin (i.e., cefazolin, cefdinir, cefepime, cefoxitin, and ceftriaxone) unless the reaction is labeled as Stevens‐Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), allergic interstitial nephritis (AIN), drug reaction with eosinophilia and systemic symptoms (DRESS), serum sickness, or hemolytic anemia. Therefore, providers should really investigate the reaction prior to determining that a cephalosporin cannot be administered 32,33 …”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS^®) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items

Powers,

Ponder,

Findley

et al. 2024

World j. surg.

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IntroductionWorldwide, ERAS® Society guidelines have ushered in a new era of perioperative care. The purpose of this systematic review is to compare published core elements and pharmacotherapy recommendations embedded within ERAS® Society abdominal and thoracic surgery (ATS) guidelines. Determining whether a consensus exists for pharmacological core items would make future guideline preparation for similar surgeries more standardized and could improve patient care by reducing unnecessary protocol variations.MethodsFrom the ERAS® Society website as of May 2023, 16 current ERAS® published ATS guidelines were included in the analysis to determine consensus and differing statements regarding each ERAS® perioperative and pharmacotherapy‐related item. The aims were to (a) determine whether a consensus for each item could be derived, (b) identify gaps in ERAS® protocol development, and (c) propose potential research directions for addressing the identified gaps in the literature.ResultsCore items with consensus included: preoperative smoking and alcohol cessation; avoiding bowel reparation and fasting; multimodal preanesthetic, perioperative analgesia, and postoperative nausea and vomiting regimens; low molecular weight heparins for in‐hospital and at‐home venous thromboembolism prophylaxis; antibiotic prophylaxis; skin preparation; goal‐directed perioperative fluid management with balanced crystalloids; perioperative nutrition care; ileus prevention with peripherally‐acting mu receptor antagonists; and glucose control.ConclusionWhile consensus was found for aspects of 21 current ERAS® guideline core items related to pharmacotherapy choice, details related to doses, regimen, timing of administration as well as unique aspects pertaining to specific surgeries remain to be researched and harmonized to promote guideline consistency and further optimize patient outcomes.

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“…The unique advantages of robotic technology provide a solid foundation for the development of RARC based on ERAS-related surgical nursing techniques [ 3 ]. ERAS nursing, which involves evidence-based approaches throughout the perioperative period, has proved to significantly reduce complications and hospital stays in robot-assisted surgeries [ 4 ]. Nurses play a pivotal role as direct operators in the execution of ERAS plans [ 5 ], are integral to the success of ERAS-based perioperative nursing.…”

Section: Introductionmentioning

confidence: 99%

Effect of RARC-ERAS nursing program on clinical outcomes in patients undergoing RARC surgery: a retrospective, propensity matching study

He,

Zhou,

et al. 2024

J Robotic Surg

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Currently, there is no specific perioperative nursing standard for RARC based on the ERAS concept. This retrospective study investigates to analyze the effect of RARC-ERAS nursing program on VTE and other clinical outcomes in patients undergoing RARC surgery. This retrospective study included 216 patients undergoing RARC surgery From January 1, 2022 to December 30, 2023, and propensity score adjustment analysis was applied. The study compares a control group receiving traditional nursing and an observation group receiving RARC-ERAS nursing program. Perioperative variables and other postoperative complications were retrieved from the hospital medical records. After propensity score matching, there were no significant differences in the demographic and clinical characteristics between the two groups (p > 0.05). The ERAS group exhibited aa significantly higher rate of postoperative unobstructed venous blood flow in the lower extremities by color Doppler ultrasound as compared to the control group (94.6% VS 80.4%, p = 0.042). Before anesthesia induction, lower preoperative anxiety and surgical information needs scores were observed in the ERAS group than in the control group (p < 0.05). Compared to the control group, the ERAS group demonstrated a shorter surgical duration, a lower incidence of perioperative hypothermia, less time needed for getting out of bed, anal exhaust, and for defecation after returning to the ward (p < 0.05). RARC-ERAS nursing program significantly increased the rate of postoperative unobstructed venous blood flow in the lower extremities by color doppler ultrasound, lower preoperative anxiety and intraoperative hypothermia in patients undergoing RARC. This nursing approach presents a valuable strategy for enhancing patient outcomes and merits further exploration in clinical practice.Trial registration:ChiCTR2400081118; http://www.chictr.org.cn, Principal investigator: Mang-mang He, Date of registration: Feb 22, 2024.

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Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update

Cited by 44 publications

References 127 publications

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Enhanced recovery after surgery (ERAS^®) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items

Effect of RARC-ERAS nursing program on clinical outcomes in patients undergoing RARC surgery: a retrospective, propensity matching study

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Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update

Cited by 44 publications

References 127 publications

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Enhanced recovery after surgery (ERAS®) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items

Effect of RARC-ERAS nursing program on clinical outcomes in patients undergoing RARC surgery: a retrospective, propensity matching study

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Enhanced recovery after surgery (ERAS^®) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items