Introduction/Background*Enhanced recovery after surgery (ERAS) protocals aim to improve clinical outcomes and provide a cost benefit to the healthcare system. This approach is widely accepted as the goal in perioperative care, but implementation varies widely. The ERAS Society updated their guidelines for perioperative care in gynecological oncology in early 2019.
Methodology Retrospective review of implementation of ERAS recommendations in a gynaecological oncology service in the west of Ireland. Data collection through review of patient charts for all major surgeries in the service over 4months (September-December 2019 inclusive).
Result(s)*Total cohort of patients undergoing surgery during this time period was 41 women. One cervical cancer, 13 endometrial cancers and 27 tubo-ovarian pathologies. No pre-habilitation and verbal education only offered. Successful smoking cessation (>4/52) in 50% of smokers. Bowel preparation used in 2.4% of patients. Length of time fasting; 6-8hours (10%), 8-12hours (46%), and 12-16hours (44%), no carbohydrate loading pre-operatively. Compliance was 100% with anti-microbial prophylaxis, normothermia maintenance, and chlorhexidine based skin preparation at surgery, but no pre-operative chlorhexidine based showers recorded. Peritoneal drains were used in 34% of cases, and there was no strict maintenance of normoglycaemia. There was 100% compliance with intra-operative/post-operative dual mechanical/chemo- thromboprophylaxis, but no pre-operative, nor extended post-operative thromboprophylaxis. General anaesthetic in 100% cases. No sedatives given pre-operatively and 42% underwent minimally invasive surgery. At laparotomy, 92% had a thoracic epidural sited (average use 2.5days), and 12.5% had patient controlled analgesia. Multi-modal anti-emetics used in 68% of cases and an nasogastric tube placed in 2.4%. Postoperative opiates prescribed in 90%, NSAIDs in 93%, no use of gabapentin recorded. Oral diet resumed in under 24hours for 61%, with 39% resuming diet in the following 24hour period. Urinary catheters were removed in under 24hours for 42% of patients, with 24% and 34% in the following 24hour periods respectively (71% of which were related to ongoing epidural use). All patients without epidurals mobilised in under 24 hours. Of those with epidurals, 77% mobilised between 24-48 hours.
Conclusion*Mixed compliance is demonstrated with ERAS guidance. There is excellent compliance in the area of surgical-site infection prevention. Improved pre-operative education, reduced fasting times, carbohydrate loading, pre- and post-operative extended thromboprophylaxis and reduced opiate use would improve ERAS compliance rates.
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