Implementation of Enhanced Recovery after Surgery for Endometrial Carcinoma: A Non-Randomized Controlled Trial

Sanad, Ahmad Sameer; El-Gindi, Essam; Elkhateeb, Reham; Abdl-Ghany, Ahmed M; Abdelrazik, AmrNady; Mousa, Ahmed; Hafiz, AhmedShoukry

doi:10.5958/0976-5506.2019.02747.5

Cited by 4 publications

(3 citation statements)

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“…Literature searches and multidisciplinary consensus meetings were used to design care pathways [29, 40]. Implementation was facilitated by the establishment of improvement teams and allocation of formal roles, including a dedicated supervisor for the entire pathway [30, 44, 46]. Senior clinicians with influence within a department often led implementation [28, 34, 45].…”

Section: Resultsmentioning

confidence: 99%

Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis

et al. 2022

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Background Safe and effective care for surgical patients requires high-quality perioperative care. In high-income countries (HICs), care pathways have been shown to be effective in standardizing clinical practice to optimize patient outcomes. Little is known about their use in low- and middle-income countries (LMICs) where perioperative mortality is substantially higher. Methods Systematic review and narrative synthesis to identify and describe studies in peer-reviewed journals on the implementation or evaluation of perioperative care pathways in LMICs. Searches were conducted in MEDLINE, EMBASE, CINAHL Plus, WHO Global Index, Web of Science, Scopus, Global Health and SciELO alongside citation searching. Descriptive statistics, taxonomy classifications and framework analyses were used to summarize the setting, outcome measures, implementation strategies, and facilitators and barriers to implementation. Results Twenty-seven studies were included. The majority of pathways were set in tertiary hospitals in lower-middle-income countries and were focused on elective surgery. Only six studies were assessed as high quality. Most pathways were adapted from international guidance and had been implemented in a single hospital. The most commonly reported barriers to implementation were cost of interventions and lack of available resources. Conclusions Studies from a geographically diverse set of low and lower-middle-income countries demonstrate increasing use of perioperative pathways adapted to resource-poor settings, though there is sparsity of literature from low-income countries, first-level hospitals and emergency surgery. As in HICs, addressing patient and clinician beliefs is a major challenge in improving care. Context-relevant and patient-centered research, including qualitative and implementation studies, would make a valuable contribution to existing knowledge.

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Section: Resultsmentioning

confidence: 99%

Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis

et al. 2022

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“…Many studies looking at length of stay in ERAS gynecologic oncology were performed using a cohort methodology with a historical (often retrospective) control cohort. Studies in this population vary in size from under 100 patients [ 11 , 12 , 13 ] to over 500 patients [ 14 , 15 , 16 , 17 ] and demonstrated anywhere from a 0 to 3 day reduction in median length of stay. One such study was published in 2013 by Kalogera and colleagues and examined the effect of implementing enhanced recovery pathways on a cohort of patients undergoing staging and cytoreductive surgery for gynecologic cancer (the study also assessed urogynecology procedures).…”

Section: Outcomes Of Eras Implementationmentioning

confidence: 99%

“…Given that MIS has been independently shown to improve postoperative pain, complications, and length of stay, opponents of ERAS have argued that the observed benefit in outcomes in many studies are due to the influence of MIS alone and not the other evidence-based interventions in ERAS protocols. Although the possibility of this bias does exist in some publications in gynecologic oncology, owing to increased rates of minimally invasive surgery following ERAS implementation [ 12 , 45 , 46 ], many studies address and correct for this within their study design and analysis. The majority of published studies of ERAS in gynecologic oncology either limited their analysis to open abdominal cases [ 13 , 14 , 36 , 47 , 48 ], minimally invasive cases [ 19 , 27 , 49 ], or performed dedicated subgroup analyses [ 21 , 50 ] to account for differences between open and MIS cohorts.…”

Section: Effect Of Surgical Approachmentioning

confidence: 99%

Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynecologic Oncology: A Review

Bisch

Nelson

2022

Current Oncology

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Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement program that started in colorectal surgery and has now expanded to numerous specialties, including gynecologic oncology. ERAS guidelines comprise multidisciplinary, evidence-based recommendations in the preoperative, intraoperative, and postoperative period; these interventions broadly encompass patient education, anesthetic choice, multimodal pain control, avoidance of unnecessary drains, maintenance of nutrition, and prevention of emesis. Implementation of ERAS has been shown to be associated with improved clinical outcomes (length of hospital stay, complications, readmissions) and cost. Marx and colleagues first demonstrated the feasibility of ERAS in gynecologic oncology in 2003; since then, over 30 comparative studies and 4 guidelines have been published encompassing major gynecologic surgery, cytoreductive surgery, and vulvar/vaginal surgery. Implementation of ERAS in gynecologic oncology has been demonstrated to provide improvements in length of stay, complications, cost, opioid use, and patient satisfaction. Increased compliance with ERAS guidelines has been associated with greater improvement in outcomes.

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Perioperative enhanced recovery programmes for women with gynaecological cancers

Chau

Liu

et al. 2022

Cochrane Database of Systematic Reviews

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Implementation of Enhanced Recovery after Surgery for Endometrial Carcinoma: A Non-Randomized Controlled Trial

Cited by 4 publications

References 0 publications

Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis

Perioperative Care Pathways in Low‐ and Lower‐Middle‐Income Countries: Systematic Review and Narrative Synthesis

Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynecologic Oncology: A Review

Perioperative enhanced recovery programmes for women with gynaecological cancers

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