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Compliance with enhanced recovery after surgery program in gynecology: are all items of equal importance?
  1. Basile Pache1,2,
  2. Jonas Jurt1,
  3. Fabian Grass1,
  4. Martin Hübner1,
  5. Nicolas Demartines1,
  6. Patrice Mathevet2 and
  7. Chahin Achtari2
  1. 1Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  2. 2Service of Gynecology, Department “Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  1. Correspondence to Dr Basile Pache, Gynaecology and Obstetrics, Centre Hospitalier Universitaire Vaudois, Lausanne 1011, Switzerland; basile.pache{at}


Introduction Enhanced recovery after surgery (ERAS) guidelines in gynecologic surgery are a set of multiple recommendations based on the best available evidence. However, according to previous studies, maintaining high compliance is challenging in daily clinical practice. The aim of this study was to assess the impact of compliance to individual ERAS items on clinical outcomes.

Methods Retrospective cohort study of a prospectively maintained database of 446 consecutive women undergoing gynecologic oncology surgery (both open and minimally invasive) within an ERAS program from 1 October 2013 until 31 January 2017 in a tertiary academic center in Switzerland. Demographics, adherence, and outcomes were retrieved from a prospectively maintained database. Uni- and multivariate logistic regression was performed, with adjustment for confounding factors. Main outcomes were overall compliance, compliance to each individual ERAS item, and impact on post-operative complications according to Clavien classification.

Results A total of 446 patients were included, 26.2 % (n=117) had at least one complication (Clavien I–V), and 11.4 % (n=51) had a prolonged length of hospital stay. The single independent risk factor for overall complications was intra-operative blood loss > 200 mL (OR 3.32; 95% CI 1.6 to 6.89, p=0.001). Overall compliance >70% with ERAS items (OR 0.15; 95% CI 0.03 to 0.66, p=0.12) showed a protective effect on complications. Increased compliance was also associated with a shorter length of hospital stay (OR 0.2; 95% CI 0.435 to 0.93, p=0.001).

Conclusions Compliance >70% with modifiable ERAS items was significantly associated with reduced overall complications. Best possible compliance with all ERAS items is the goal to achieve lower complication rates after gynecologic oncology surgery.

  • surgical oncology
  • postoperative care
  • preoperative care

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  • BP and JJ are shared first authorship.

  • Contributors BP: data acquisition, conception, design, analysis and interpretation, drafting, critical revision. JJ: data acquisition, conception, design, analysis and interpretation, drafting, critical revision. FG: analysis and interpretation, drafting, critical revision. MH: conception, design, interpretation, critical revision. ND: analysis and interpretation, critical revision. PM: analysis and interpretation, critical revision. CA: conception, interpretation, critical revision. All authors read and approved the final manuscript.

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval Approved by the local review board 'Commission Cantonale d’éthique Vaud' (CER-VD # 2017–01996).

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