Enhanced Recovery Pathway in Gynecologic Surgery: Improving Outcomes Through Evidence-Based Medicine

Obstet Gynecol Clin North Am. 2016 Sep;43(3):551-73. doi: 10.1016/j.ogc.2016.04.006.


A paucity of data exists regarding traditional perioperative practices (bowel preparation, NPO at midnight, liberal narcotics, PCA use, liberal fluids, prolonged bowel and bed rest). Enhanced Recovery after Surgery (ERAS) is an evidence-based approach to peri-operative care associated with improved outcomes including earlier return of gastrointestinal function, reduced opioid use, shorter hospital stay, and substantial cost reductions with stable complication and readmission rates. Basic principles include patient education, minimizing preoperative fasting, avoiding bowel preparation, preemptive analgesia, nausea/vomiting prophylaxis, perioperative euvolemia, no routine use of drain and nasogastric tubes, early mobilization, oral intake, and catheter removal, non-opioid analgesics, and preemptive laxatives.

Keywords: Abdominal hysterectomy; Benign; Enhanced recovery; Gynecologic surgery; Laparoscopic hysterectomy; Perioperative care; Vaginal hysterectomy.

Publication types

  • Review

MeSH terms

  • Critical Pathways
  • Evidence-Based Medicine
  • Female
  • Genital Diseases, Female / physiopathology
  • Genital Diseases, Female / surgery*
  • Gynecologic Surgical Procedures* / methods
  • Humans
  • Patient Outcome Assessment
  • Postoperative Care / methods*
  • Postoperative Complications / physiopathology
  • Postoperative Complications / prevention & control*
  • Practice Guidelines as Topic
  • Recovery of Function