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Adoption of enhanced recovery after laparotomy in gynecologic oncology
  1. Ana Sofia Ore1,
  2. Matthew A Shear1,2,
  3. Fong W Liu1,2,
  4. John L Dalrymple1,2,
  5. Christopher S Awtrey1,2,
  6. Leslie Garrett1,2,
  7. Hannah Stack-Dunnbier1,
  8. Michele R Hacker1,2 and
  9. Katharine McKinley Esselen1,2
  1. 1 Obstetrics and gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2 Obstetrics, gynecology and reproductive biology, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Katharine McKinley Esselen, OB/GYN, Boston, MA 02115, USA; kesselen{at}bidmc.harvard.edu

Abstract

Introduction Enhanced recovery after surgery (ERAS) pathways combine a comprehensive set of peri-operative practices that have been demonstrated to hasten patient post-operative recovery. We aimed to evaluate the adoption of ERAS components and assess attitudes towards ERAS among gynecologic oncologists.

Methods We developed and administered a cross-sectional survey of attending, fellow, and resident physicians who were members of the Society of Gynecologic Oncology in January 2018. The χ2 test was used to compare adherence to individual components of ERAS.

Results There was a 23% survey response rate and we analyzed 289 responses: 79% were attending physicians, 57% were from academic institutions, and 64% were from institutions with an established ERAS pathway. Respondents from ERAS institutions were significantly more likely to adhere to recommendations regarding pre-operative fasting for liquids (ERAS 51%, non-ERAS 28%; p<0.001), carbohydrate loading (63% vs 16%; p<0.001), intra-operative fluid management (78% vs 32%; p<0.001), and extended duration of deep vein thrombosis prophylaxis for malignancy (69% vs 55%; p=0.003). We found no difference in the use of mechanical bowel preparation, use of peritoneal drainage, or use of nasogastric tubes between ERAS and non-ERAS institutions. Nearly all respondents (92%) felt that ERAS pathways were safe.

Discussion Practicing at an institution with an ERAS pathway increased adoption of many ERAS elements; however, adherence to certain guidelines remains highly variable. Use of bowel preparation, nasogastric tubes, and peritoneal drainage catheters remain common. Future work should identify barriers to the implementation of ERAS and its components.

  • laparotomy
  • surgical oncology
  • postoperative care
  • preoperative care
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Footnotes

  • ASO and MAS contributed equally.

  • Contributors ASO: study conception and design; data analysis; critically revising the manuscript; approval of final manuscript. MAS: study design; data interpretation; drafting the manuscript; approval of final manuscript. FWL: study design; critically revising the manuscript; approval of final manuscript. JLD: study design; critically revising the manuscript; approval of final manuscript. CA: study design; critically revising the manuscript; approval of final manuscript. LG: study design; critically revising the manuscript; approval of the final manuscript. HS-D: data analysis; critically revising the manuscript; approval of the final manuscript. MRH: study design; data analysis and interpretation; critically revising the manuscript; approval of final manuscript. KME: study conception and design; data interpretation; drafting the manuscript; approval of final manuscript.

  • Funding This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers.

  • Disclaimer The funding sources had no involvement in the study design, collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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