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

Nelson, Gregg; Bakkum-Gamez, Jamie N.; Kalogera, Eleftheria; Glaser, Gretchen; Altman, Alon D.; Meyer, Larissa A.; Taylor, Jolyn; Iniesta, Maria D.; Lasala, Javier; Mena, Gabriel E.; Scott, Michael J.; Gillis, Chelsia; Elias, Kevin M.; Wijk, Lena; Huang, Jeffrey; Nygren, Jonas; Ljungqvist, Olle; Ramírez, Pedro T.; Dowdy, Sean C.

doi:10.1136/ijgc-2019-000356

Cited by 472 publications

(349 citation statements)

References 247 publications

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“…In the traditional preoperative preparation for total pelvic floor reconstruction, strict bowel preparation and fasting are required to prevent infection and lung inhalation. A meta-analysis by Nelson et al 15 suggested that bowel preparation should not be routinely used in gynecological minimally invasive surgeries or laparotomy surgeries. A retrospective cohort study showed that this approach was safe for patients undergoing transvaginal POP surgery who did not undergo routine bowel preparation via the ERAS pathway.…”

Section: Cathetermentioning

confidence: 99%

Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh

Gong

Liú

et al. 2019

Intl J Gynecology & Obste

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Objective To investigate the impact of enhanced recovery after surgery (ERAS) on perioperative outcomes after total pelvic floor reconstruction surgery with transvaginal mesh. Methods A single‐center, retrospective observational cohort study involved 177 patients who underwent total pelvic floor reconstruction surgery with transvaginal mesh between August 2015 and November 2017. Eighty‐five patients treated according to a traditional protocol formed the control group and 92 patients treated using the ERAS pathway were assigned to the ERAS group. Registered outcomes included demographic characteristics, intraoperative and postoperative data (first assisted walking time, first intestinal exhaust time, length of stay, hospital costs), and complications. Results The first assisted walking time (40.6 ± 1.48 vs 23.56 ± 3.26 hours, P<0.001) and the first intestinal exhaust time (27.65 ± 11.63 vs 18.65 ± 10.68 hours, P<0.001) were earlier in the ERAS group. The implementation of the ERAS pathway was associated with shorter length of stay (121.35 vs 70.25 hours, P<0.001) and lower hospital costs (46 838.65 ± 2584.08 vs 42 793.57 ± 2560.3 RMB, P<0.001). There was no difference in surgical outcomes or postoperative complications between the two groups. Conclusion ERAS is safe, economical, and reliable after total pelvic floor reconstruction surgery and promotes perioperative recovery without increasing complication rates.

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Section: Cathetermentioning

confidence: 99%

Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh

Gong

Liú

et al. 2019

Intl J Gynecology & Obste

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“…1 Therefore, ERAS programs recommend pre-operative carbohydrate loading to minimize the catabolic influence of the surgical stress response. 6 Five studies (three randomized controlled trials, one systematic review, and one cohort study) were identified for physical interventions before surgery in our literature review and are summarized in this section. A recent Cochrane systematic review concluded that pre-operative carbohydrate treatment compared with placebo or fasting reduces the length of hospital stay (0.30 days, 95% CI 0.56 to 0.04) in patients undergoing elective surgery (abdominal, orthopedic, cardiac, and thyroidectomy), although it has no significant effect on post-operative complication rates.…”

Section: Nutritional Interventionmentioning

confidence: 99%

Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

Miralpeix

Mancebo

Gayete

et al. 2019

Int J Gynecol Cancer

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Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.

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“…Guidelines for preoperative CHO loading and postoperative early oral feeding in gynecologic cancer patients under ERAS setting were updated [18]. However, the impact of providing whey protein-infused CHO loading drinks as preoperative CHO loading among surgical GC patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Ibrahim

Zaid

et al. 2020

Nutrients

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Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

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

Cited by 472 publications

References 247 publications

Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh

Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh

Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

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