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Outcomes of open radical hysterectomy following implementation of an enhanced recovery after surgery program
  1. Nuria Agusti1,
  2. Andrés Zorrilla Vaca2,3,
  3. Blanca Segarra-Vidal4,
  4. Maria D Iniesta5,
  5. Gabriel Mena2,
  6. Rene Pareja6,
  7. Ricardo Dos Reis7 and
  8. Pedro T Ramirez5
  1. 1Department of Gynecologic Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
  2. 2Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  4. 4Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
  5. 5Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Medellin, Colombia
  7. 7Department of Gynecologic Oncology, Hospital de Cancer de Barretos, Barretos, Brazil
  1. Correspondence to Dr Pedro T Ramirez, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; peramire{at}


Objective Open surgery has become the standard approach for radical hysterectomy in early stage cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2018 IA1 with lymphovascular space invasion-IIA1). Our primary objective was to compare the length of stay in patients undergoing open radical hysterectomy before and after implementation of an enhanced recovery after surgery (ERAS) program.

Methods This was a single center, retrospective, before-and-after intervention study including patients who underwent open radical hysterectomy for cervical cancer from January 2009 to December 2020. Two groups were identified based on the time of ERAS implementation: pre-ERAS group included patients who were operated on between January 2009 and October 2014; post-ERAS group included patients who underwent surgery between November 2014 and December 2020.

Results A total of 81 patients were included, of whom 29 patients were in the pre-ERAS group and 52 patients in the post-ERAS group. Both groups had similar clinical characteristics with no differences in terms of median age (42 years (interquartile range (IQR) 35–53) in pre-ERAS group vs 41 years (IQR 35–49) in post-ERAS group; p=0.47) and body mass index (26.1 kg/m2 (IQR 24.6–29.7) in pre-ERAS group vs 27.1 kg/m2 (IQR 23.5–33.5) in post-ERAS group; p=0.44). Patients in the post-ERAS group were discharged from the hospital earlier compared with those in the pre-ERAS group (median 3 days (IQR 2–3) vs 4 (IQR 3–4), p<0.01). The proportion of patients discharged within 48 hours was significantly higher in the post-ERAS group (47.3% vs 17.3%, p=0.013). There were no differences regarding either overall complications (44.8% pre-ERAS vs 38.5% post-ERAS; p=0.57) or readmission rates within 30 days (20.7% pre-ERAS group vs 17.3% ERAS group; p=0.40). Adherence to the ERAS pathway since its implementation in 2014 has remained stable with a median of 70% (IQR 65%–75%).

Conclusions Patients undergoing open radical hysterectomy on an ERAS pathway have a shorter length of hospital stay without increasing overall complications or readmissions rates.

  • cervical cancer
  • gynecologic surgical procedures
  • postoperative complications
  • surgical oncology
  • postoperative care

Data availability statement

Data are available upon reasonable request.

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  • Twitter @BSegarraVidal, @gabemenaMD, @pedroramirezMD

  • Contributors NA: project development, investigation, project administration, and manuscript writing. AZV: data analysis. BS-V, GM, and RP: project development. MDI: project development and project administration. RDR: data collection. PTR: project conceptualization and development, project administration, and manuscript writing. PTR is responsible for the overall content 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.