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Surgical site infection prevention bundle in gynecology oncology surgery: a key element in the implementation of an enhanced recovery after surgery (ERAS) program
  1. Lucia Ribero1,
  2. María Clara Santía2,
  3. Kathleen Borchardt2,
  4. Firaz Zabaneh3,
  5. Amanda Beck4,
  6. Archana Sadhu5,
  7. Karen Edwards2,
  8. Monica Harrelson2,
  9. Aimee Pinales-Rodriguez2,
  10. Elise Mann Yates2 and
  11. Pedro T Ramirez2
    1. 1Division of Gynecologic Surgery, European Institute of Oncology, Milan, Italy
    2. 2Department of Obstetrics and Gynecology, Houston Methodist Hospital Neal Cancer Center, Houston, Texas, USA
    3. 3Department of System Infection Control, Houston Methodist Hospital, Houston, Texas, USA
    4. 4Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA
    5. 5Department of Endocrinology, Houston Methodist Hospital, Houston, Texas, USA
    1. Correspondence to Dr Lucia Ribero, Division of Gynecologic Surgery, European Institute of Oncology, Milan 20141, Italy; luribero269{at}


    Surgical site infection rates are among 5–35% in all gynecologic oncology procedures. Such infections lead to increased patient morbidity, reduction in quality of life, higher likelihood of readmissions, and reinterventions, which contribute directly to mortality and increase in health-related costs. Some of these are potentially preventable by applying evidence-based strategies in the peri-operative patient setting. The objective of this review is to provide recommendations for the individual components that most commonly comprise the surgical site infection prevention bundles that could be implemented in gynecologic oncology procedures. We searched articles from relevant publications with specific topics related to each surgical site infection intervention chosen to be reviewed. Studies on each topic were selected with an emphasis on meta-analyses, systematic reviews, randomized control studies, non-randomized controlled studies, reviews, clinical practice guidelines, and case series. Data synthesis was done through content and thematic analysis to identify key themes in the included studies. This review intends to serve as the most up-to-date frame of evidence-based peri-operative care in our specialty and could serve as the first initiative to introduce an enhanced recovery after surgery (ERAS) program.

    • Surgical Oncology
    • Gynecologic Surgical Procedures
    • Preoperative Care
    • Postoperative Care
    • Surgical Wound Infection

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    • X @luribero26, @claritasantia, @pedroramirezMD

    • Contributors LR and MCS designed and performed the study. PTR conceived of the presented idea. All authors discussed the results and commented on the 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.

    • 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.