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Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update
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  1. Gregg Nelson1,
  2. Jamie Bakkum-Gamez2,
  3. Eleftheria Kalogera3,
  4. Gretchen Glaser4,
  5. Alon Altman5,
  6. Larissa A Meyer6,
  7. Jolyn S Taylor7,
  8. Maria Iniesta6,
  9. Javier Lasala8,
  10. Gabriel Mena8,
  11. Michael Scott9,
  12. Chelsia Gillis10,
  13. Kevin Elias11,
  14. Lena Wijk12,
  15. Jeffrey Huang13,
  16. Jonas Nygren14,
  17. Olle Ljungqvist15,
  18. Pedro T Ramirez16 and
  19. Sean C Dowdy17
  1. 1 Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
  2. 2 Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  3. 3 Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  4. 4 Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  5. 5 Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  6. 6 Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  7. 7 Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  8. 8 Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  9. 9 Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, Virginia, USA
  10. 10 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  11. 11 Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
  12. 12 Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
  13. 13 Department of Anesthesiology, Oak Hill Hospital, Brooksville, Florida, USA
  14. 14 Departments of Surgery and Clinical Sciences, Ersta Hospital and Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
  15. 15 Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
  16. 16 Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  17. 17 Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Gregg Nelson, Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB T2N4N2, Canada; gsnelson{at}ucalgary.ca

Abstract

Background This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.

Methods A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

Results All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.

Conclusions The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

  • preoperative care
  • postoperative care
  • surgery
  • Enhanced Recovery After Surger
  • intraoperative care
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Footnotes

  • PTR and SCD are joint senior authors.

  • Contributors I confirm that each author: was involved in substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; was involved in drafting the work or revising it critically for important intellectual content; was involved in final approval of the version submitted; agrees to be accountable for all aspects of the work.

  • 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 GN is the Secretary for the ERAS® Society. MS received honoraria for lecturing and travel expenses from Baxter Healthcare, Merck, and Deltex. He is an Executive Committee member of the ERAS® Society. AA has received speaker’s honoraria from Sanofi and AstraZeneca, and is on the Advisory Board of AstraZeneca. GM is a consultant for ConMed and Edwards Lifesciences and has stock options with Pacira Pharmaceutical. OL has an appointment with Nutricia Advisory Board, has given advice to MSD, Abbot and Advanced Medical Nutrition. He has received speaker’s honoraria from Nutricia, MSD, BBraun, Medtronic and Fresenius-Kabi. He is the current Chairman of the ERAS® Society. He founded, and owns stock in, Encare AB that runs the ERAS® Society Interactive Audit System (EIAS). SD is a member of the Board of Directors for ERAS® USA and a content expert for the AHRQ program for improving surgical care and recovery.

  • Patient consent for publication Not required.

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

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