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Enhanced Recovery After Surgery for Suspected Ovarian Malignancy: A Survey of Perioperative Practice Among Gynecologic Oncologists in Australia and New Zealand to Inform a Clinical Trial
  1. Kristina Lindemann, MD, PhD*,,,§,
  2. Peey-Sei Kok, MD*,,
  3. Martin Stockler, MD, PhD*,,
  4. Peter Sykes, MD and
  5. Alison Brand, MD, PhD,,**
  1. *NHMRC Clinical Trials Centre, University of Sydney; and
  2. Australian New Zealand Gynecological Oncology Goup (ANZGOG), Camperdown; and
  3. Crown Princess Mary Cancer Centre, Westmead Hospital, Wentworthville, New South Wales, Australia;
  4. §Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway;
  5. Institute of Clinical Medicine, University of Oslo, Faculty of Medicine, Oslo, Norway;
  6. Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand; and
  7. **Department of Gynaecological Oncology, Westmead Hospital, Wentworthville, New South Wales, Australia.
  1. Address correspondence and reprint requests to Kristina Lindemann, MD, PhD, Department of Gynecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, PO 4953 Nydalen, 0424 Oslo, Norway. E-mail address: klinde@ous-hf.no.

Abstract

Objectives The objective of this survey was to review the current standard of perioperative care of patients with suspected advanced ovarian cancer in Australia and New Zealand in order to determine the level of equipoise for specific interventions.

Methods In May 2016, a web-based questionnaire (SurveyMonkey Inc, Palo Alto, CA) was sent to all gynecologic oncologists in Australia and New Zealand (n = 56). Descriptive statistics were used.

Results Response rate was 75%. Prevention of hypothermia, extended thromboembolic prophylaxis, antibiotic prophylaxis, and the avoidance of the routine use of drains were standard of care. Bowel preparation was given by 10% routinely and by 35% when bowel resection was planned. Fasting times for fluids of six hours or more were common (55%). Only 26% had shortened fasting times of two hours. Twelve percent used carbohydrate loading. The majority of patients started a light diet within the first postoperative day and advanced diet subsequently as tolerated. Six respondents (15%) used thoracic epidural, whereas the majority (73%) administered an opioid-based intravenous patient-controlled analgesia as the predominant postoperative analgesia, mainly as part of a multimodal pain management. The majority of respondents expressed an interest in a trial concept of individual ERAS interventions.

Conclusions Only a minority of ERAS interventions can be considered standard of care in ovarian cancer surgery. The existing level of equipoise among gynecologic oncologists in Australia and New Zealand, and their interest in a trial concept of individual ERAS interventions allows further assessment of the feasibility and efficacy of interventions in a randomized controlled trial.

  • ERAS
  • Fast-track
  • Ovarian cancer
  • Perioperative care
  • Survey

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Footnotes

  • The authors declare no conflicts of interest.

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