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

G Nelson; C Fotopoulou; J Taylor; G Glaser; J Bakkum-Gamez; L A Meyer; R Stone; G Mena; K M Elias; A D Altman; S P Bisch; P T Ramirez; S C Dowdy

doi:10.1016/j.ygyno.2023.04.009

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

Gynecol Oncol. 2023 Jun:173:58-67. doi: 10.1016/j.ygyno.2023.04.009. Epub 2023 Apr 21.

Authors

G Nelson¹, C Fotopoulou², J Taylor³, G Glaser⁴, J Bakkum-Gamez⁴, L A Meyer³, R Stone⁵, G Mena⁶, K M Elias⁷, A D Altman⁸, S P Bisch⁹, P T Ramirez¹⁰, S C Dowdy⁴

Affiliations

¹ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: gsnelson@ucalgary.ca.
² Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
³ Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN, USA.
⁵ Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Department of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁷ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
⁸ Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁹ Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, USA.

PMID: 37086524
DOI: 10.1016/j.ygyno.2023.04.009

Abstract

Background: Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges.

Methods: Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

Results: All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly.

Conclusions: The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.

Keywords: ERAS; Enhanced recovery after surgery; Gynecologic oncology surgery; Perioperative care; Surgical quality.

Publication types

Review

MeSH terms

Enhanced Recovery After Surgery*
Female
Genital Neoplasms, Female* / surgery
Gynecologic Surgical Procedures
Humans
Perioperative Care
Prospective Studies