Enhanced recovery after surgery in gynecologic oncology

Abstract

Enhanced recovery protocols consist of a bundle of concepts including early feeding, opioid‐sparing multimodal pain management, and euvolemia, with the overarching goal of hastening postoperative recovery. Enhanced recovery after surgery has been shown to reduce hospital length of stay, reduce costs, and decrease perioperative opioid requirements in benign and oncologic gynecologic surgery. Interventions without supporting evidence of benefit, such as the use of mechanical bowel preparation, routine use of nasogastric tubes and surgical drains, caloric restriction, routine use of intravenous opioid analgesics, and over‐vigorous intravenous hydration should be discouraged to improve broader endpoints such as patient satisfaction and overall recovery. Successful implementation requires engagement from a multidisciplinary team including surgeons, anesthesiologists, nurses, and pharmacists.

Factors Influencing Postoperative Recovery and Time Off Work of Patients with Benign Indications for Surgery – Results of a Prospective Study

“…The development and implementation of so-called Fast Track Surgery (FTS) or Enhanced Recovery After Surgery (ERAS) programs to reduce time in hospital, complication rates, the rates of readmission to hospital, and hospital costs are now quite common 36 , 37 , 38 . Such programs mainly focus on the immediate postoperative phase when patients are still in hospital.…”

“…Die Entwicklung und Implementierung sogenannter Fast-Track-Surgery- (FTS) oder Enhanced-Recovery-After-Surgery-Programme (ERAS), um u. a. die stationäre Verweildauer, die Komplikationsrate, die Krankenhauswiederaufnahmerate und Krankenhauskosten zu verringern, ist inzwischen weit verbreitet 36 , 37 , 38 . Diese Programme konzentrieren sich vor allem auf die unmittelbar postoperative Phase, in der sich die Patienten noch im Krankenhaus befinden.…”

Evaluating Implementation Costs of an Enhanced Recovery After Surgery (ERAS) Protocol in Colorectal Surgery: A Systematic Review

“…However, ERAS guidelines have also been published for other surgical specialties. Many hospitals (both community and academic) and health systems have implemented ERAS programs for bariatric surgery [11, 12], orthopedic surgery [13], neurosurgery [14, 15], gynecologic oncology [16, 17], cardiothoracic surgery [18], and transplant surgery [19], among others. Similar results were also shown in pediatric [20] and geriatric populations [21, 22].…”

Effectiveness of an Educational Intervention with Guidelines from the Total Acceleration of Postoperative Recovery Project (ACERTO) in Gynecology

“…Derived from the solid foundations of the Enhanced Recovery After Surgery (ERAS), the ACERTO project, in Brazil and other Latin American countries, prioritizes evidence-based medicine in addition to being an educational program. [1][2][3] Currently, several medical societies, including the International Federation of Gynecology and Obstetrics (FIGO), 4 American College of Obstetricians and Gynecologists (ACOG), 5 the European Society for Clinical Nutrition and Metabolism (ESPEN), 6 and the Brazilian Federation of Gynecology and Obstetrics (FEBRASGO), 7 among others, are engaged in the development of clinical guidelines and protocols that improve the quality of perioperative care through ERAS. Mastery of the surgical technique is important; however, perioperative care favors positive surgical results, in addition to maximizing recovery, minimizing unpleasant symptoms such as pain, reducing complications such as thrombosis, and decreasing hospitalization time and hospital costs.…”

“…1 The ACERTO project, just like ERAS guide-lines, focuses on clear information to the patient about the surgery, abbreviation of preoperative fasting, early postsurgical patient ambulation, thrombosis prophylaxis, early oral refeeding, optimization of the use of drains and probes to avoid unnecessary use, hyperhydration prevention, and facilitatation of analgesia to stimulate the recovery of patients undergoing surgical treatment. [1][2][3][4][5][6][7] Despite the scientific support of the ACERTO Project's recommendations, few hospitals or services apply its guidelines in practice due to lack of knowledge and adherence of health professionals. Given this scenario, the objective of the present study was to evaluate the effectiveness of an educational intervention in the gynecology department of a university hospital on the main recommendations of the ACERTO project to foster the knowledge and adherence of professionals in the practical applicability of standardized measures, such as the abbreviation of the preoperative fasting, prophylaxis for thromboembolic events, and multimodal and humanized analgesia approach to enable postoperative recovery in gynecological surgeries.…”