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The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting
  1. Alberto A. Mendivil, MD*,
  2. Justin R. Busch, MD,
  3. David C. Richards, MD,
  4. Heather Vittori, BSN, RN and
  5. Bram H. Goldstein, PhD*
  1. * Gynecologic Oncology Associates, Hoag Memorial Hospital Cancer Center; and
  2. Newport Harbor Anesthesia Consultants, Department of Anesthesiology, and
  3. Digestive Health Institute, Hoag Memorial Hospital, Newport Beach, CA.
  1. Address correspondence and reprint requests to Bram H. Goldstein, PhD, Gynecologic Oncology Associates, 351 Hospital Rd, Suite 507, Newport Beach, CA 92663. E-mail: bram{at}


Objectives The purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion.

Methods We retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates.

Results There were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282).

Conclusions The results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.

  • Expanded recovery after surgery
  • Gynecologic oncology
  • Outcomes

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  • The authors declare no conflicts of interest.