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Enhanced Recovery After Surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice
  1. Geetu Prakash Bhandoria1,
  2. Prashant Bhandarkar2,
  3. Vijay Ahuja3,
  4. Amita Maheshwari4,
  5. Rupinder K Sekhon5,
  6. Murat Gultekin6,
  7. Ali Ayhan7,
  8. Fuat Demirkiran8,
  9. Ilker Kahramanoglu8,
  10. Yee-Loi Louise Wan9,
  11. Pawel Knapp10,
  12. Jakub Dobroch11,
  13. Andrzej Zmaczyński12,
  14. Robert Jach13 and
  15. Gregg Nelson14
  1. 1Obstetrics and Gynecology, Command Hospital Pune, Pune, Maharashtra, India
  2. 2WHO Collaborating Centre (WHOCC) for Research in Surgical Needs in LMIC, BARC Hospital, Mumbai, Maharashtra, India
  3. 3Gynecological Oncology, Manipal Hospitals, Bangalore, Karnataka, India
  4. 4Gynecologic Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
  5. 5URO-GYNAE, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
  6. 6Cancer Control Department, Turkish Ministry of Health, Ankara, Turkey
  7. 7Department of Gynecology and Obstetrics Division of Gynecologic Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
  8. 8Department of Gynecologic Oncology, Istanbul University Cerrrahpasa Medical Faculty, istanbul, Turkey
  9. 9Gynaecological Oncology, The University of Manchester Faculty of Medical and Human Sciences, Manchester, Manchester, UK
  10. 10University Oncology Center, Uniwersytet Medyczny w Bialymstoku, Bialystok, Poland
  11. 11Gynecologic Oncology, Medical University of Bialystok, Bialystok, Poland
  12. 12Department of Gynecological Endocrinology, Jagiellonian University, Krakow, Małopolska, Poland
  13. 13Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland
  14. 14Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
  1. Correspondence to Dr Geetu Prakash Bhandoria, Obstetrics & Gynecology, Command Hospital Pune, Pune, Maharashtra, India; doctor_071277{at}


Introduction Enhanced Recovery After Surgery (ERAS) programs have been shown to improve clinical outcomes in gynecologic oncology, with the majority of published reports originating from a small number of specialized centers. It is unclear to what degree ERAS is implemented in hospitals globally. This international survey investigated the status of ERAS protocol implementation in open gynecologic oncology surgery to provide a worldwide perspective on peri-operative practice patterns.

Methods Requests to participate in an online survey of ERAS practices were distributed via social media (WhatsApp, Twitter, and Social Link). The survey was active between January 15 and March 15, 2020. Additionally, four national gynecologic oncology societies agreed to distribute the study among their members. Respondents were requested to answer a 17-item questionnaire about their ERAS practice preferences in the pre-, intra-, and post-operative periods.

Results Data from 454 respondents representing 62 countries were analyzed. Overall, 37% reported that ERAS was implemented at their institution. The regional distribution was: Europe 61%, Americas 53%, Asia 30%, and Africa 17%. ERAS gynecologic oncology guidelines were well adhered to (>80%) in the domains of deep vein thrombosis prophylaxis, early removal of urinary catheter after surgery, and early introduction of ambulation. Areas with poor adherence to the guidelines included the use of bowel preparation, adoption of modern fasting guidelines, carbohydrate loading, use of nasogastric tubes and peritoneal drains, intra-operative temperature monitoring, and early feeding.

Conclusion This international survey of ERAS in open gynecologic oncology surgery shows that, while some practices are consistent with guideline recommendations, many practices contradict the established evidence. Efforts are required to decrease the variation in peri-operative care that exists in order to improve clinical outcomes for patients with gynecologic cancer globally.

  • gynecologic surgical procedures
  • ovarian cancer
  • postoperative complications
  • surgical procedures, operative
  • postoperative care
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  • Contributors Study concepts and design: GPB, PB. Data acquisition: GPB, AM, MG, YLW, RJ. Statistical analysis: PB. Manuscript preparation: GPB, PB, VA, AM, MG, IK, AZ, YLW, GN. Manuscript editing: all authors. 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 GN: Secretary of the ERAS Society.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. In accordance with the journal’s guidelines, data can be provided if requested.

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