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  • The Canadian Gynecologic Oncology Peri-operative Management Survey: re-examining Enhanced Recovery After Surgery (ERAS) recommendations

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Original research
The Canadian Gynecologic Oncology Peri-operative Management Survey: re-examining Enhanced Recovery After Surgery (ERAS) recommendations
  1. Alon D Altman1,2,
  2. Alexandre Rozenholc3,
  3. Lana Saciragic4,
  4. Xiao-qing Liu5 and
  5. Gregg Nelson6
  6. on behalf of the Society of Gynecologic Oncology of Canada (GOC) Community of Practice in ERAS
  1. 1 Gynecologic Oncology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
  2. 2 CancerCareManitoba, Research Institute in Oncology and Hematology, Winnipeg, Manitoba, Canada
  3. 3 Gynecologic Oncology Service; Obstetrics and Gynecology Service, Hopital de Gatineau, Gatineau, Quebec, Canada
  4. 4 Gynecologic Oncology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
  5. 5 Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6 Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Alon D Altman, Gynecologic Oncology, University of Manitoba College of Medicine, Winnipeg, Canada; alondaltman{at}gmail.com

Abstract

Objective Enhanced Recovery After Surgery (ERAS) is a global surgery quality improvement program associated with improved clinical outcomes across the spectrum of disciplines, including gynecologic oncology. The objective of this study was to re-survey the practice of ERAS Gynecologic Oncology guidelines across Canada, after the initial guidelines publication (2016), subsequent guidelines update (2019), and Society of Gynecologic Oncology of Canada (GOC) education events.

Methods A survey was created and developed through the GOC Communities of Practice ERAS section and distributed to all members between March and November 2021. The results of this survey were compared with the survey performed in 2015

Results The initial GOC survey in 2015 included 77/92 active gynecologic oncologists (84%) representing all provinces in Canada. The current updated survey had responses from 59/118 active gynecologic oncologists (51%) also from every province. Compared with the original survey there was a statistically significant improvement in uptake of 10 ERAS recommendations: smoking/alcohol cessation, modern fasting guidelines (allowance of clear fluids and solid food pre-operatively), carbohydrate loading, pre-operative warming, early feeding, post-operative laxative use, avoidance of nasogastric tubes and abdominal drains, foley catheter removal at 6 hours, and active mobilization (all p<0.003). Only two fields (stopping oral contraceptive medications pre-operatively and foley catheter removal post-operative day 1) showed worsening uptake across the two surveys (p<0.01). The ERAS recommendations that did not change in the examined time frame included routine use of mechanical bowel preparation, venous thromboembolism prophylaxis, pre-operative antibiotics, and additional antibiotic dosing for prolonged surgery.

Conclusions This survey demonstrates increased uptake of 10 of the ERAS guideline recommendations among Canadian gynecologic oncology providers. These findings may translate to improvements in clinical outcomes and healthcare system-level benefits including increased hospital capacity and cost savings.

  • gynecologic surgical procedures
  • surgery
  • postoperative care
  • preoperative care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ijgc-2022-003562

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @DrAlonAltman, @GreggNelsonERAS

    • Contributors All authors contributed to the work as follows: ADA: conceptualization, methodology, creation of initial survey, writing of original draft, reviewing and editing the final draft. AR: conceptualization, methodology, review of survey, review and editing of final draft. LS: conceptualization, methodology, review of survey, review and editing of final draft. X-qL: statistical analysis, review and editing of final draft. GN: conceptualization, methodology, review of survey, reviewing and editing the final draft. ADA acts as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.