Introduction We prospectively evaluated an ERAS in a large gynaecologic oncology tertiary centre serving the South East Health region in Norway.
Methods Patients undergoing laparotomy for (suspected) ovarian cancer at the Oslo University Hospital were prospectively included in a pre-implementation and post-implementation cohort. Baseline characteristics, adherence to the pathway and clinical outcomes were assessed.
Results Of the 439 patients, 235 (54%) underwent surgery for advanced ovarian cancer and 204 (46%) for a suspicious ovarian mass. Median fasting times for solids (13 vs 16 h, p<0.001) and fluids (3.7 vs 11.9 h, p<0.001) were significantly reduced. Perioperative fluid administration varied less (p<0.001) and was reduced (median 11.5 vs 15.8 ml/kg/h, p<0.001). Epidural analgesia was the mainstay of analgesia in both cohorts, but with ERAS more patients received continuous vasopressor intraoperatively (87% vs 70%, p=0.003). More patients received dual PONV prophylaxis (85% vs 64%, p<0.001). Length of stay remained unchanged for patients with advanced disease with a median of 5 days both before and after the implementation (p=0.94), but patients undergoing surgery for an ovarian mass stayed shorter in hospital after the implementation of ERAS (p=0.026). For all patients, more patients were discharged directly home as opposed to transferred to local referring hospital after ERAS implementation (70% vs 51%, p<0.001). There was no difference in re-admission rates or postoperative 30 d morbidity.
Conclusion Introduction of an ERAS pathway resulted in less variance in practice and increased adherence to current standards in perioperative management. Patients were more often able to be discharged directly home without an increase in admission rates.
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