PT - JOURNAL ARTICLE AU - Judy Hayek AU - Andres Zorrilla-Vaca AU - Larissa A Meyer AU - Gabriel Mena AU - Javier Lasala AU - Maria D Iniesta AU - Tina Suki AU - Sarah Huepenbecker AU - Katherine Cain AU - Juan Garcia-Lopez AU - Pedro T Ramirez TI - Patient outcomes and adherence to an enhanced recovery pathway for open gynecologic surgery: a 6-year single-center experience AID - 10.1136/ijgc-2022-003840 DP - 2022 Nov 01 TA - International Journal of Gynecologic Cancer PG - 1443--1449 VI - 32 IP - 11 4099 - http://ijgc.bmj.com/content/32/11/1443.short 4100 - http://ijgc.bmj.com/content/32/11/1443.full SO - Int J Gynecol Cancer2022 Nov 01; 32 AB - Objectives To evaluate compliance with an Enhanced Recovery After Surgery (ERAS) protocol for open gynecologic surgery at a tertiary center and the relationship between levels of compliance and peri-operative outcomes.Methods This retrospective cohort study was conducted between November 2014 and December 2020. Two groups were defined based on compliance level (<80% vs ≥80%). The primary outcome was to analyze overall compliance since implementation of the ERAS protocol. The secondary endpoint was to assess the relationship between compliance and 30-day re-admission, length of stay, re-operation, opioid-free rates, and post-operative complications. We also assessed compliance with each ERAS element over three time periods (P1: 2014–2016, P2: 2017–2018, P3: 2019–2020), categorizing patients according to the date of surgery. Values were compared between P1 and P3.Results A total of 1879 patients were included. Overall compliance over the period of 6 years was 74% (95% CI 71.9% to 78.2%). Mean overall compliance increased from 69.7% to 75.8% between P1 and P3. Compliance with ERAS ≥80% was associated with lower Clavien–Dindo complication rates (grades III (OR 0.55; 95% CI 0.33 to 0.93) and V (OR 0.08, 95% CI 0.01 to 0.60)), 30-day re-admission rates (OR 0.61; 95% CI 0.43 to 0.88), and length of stay (OR 0.59; 95% CI 0.47 to 0.75). No difference in opioid consumption was seen. Pre-operatively, there was increased adherence to counseling by 50% (p=0.01), optimization by 21% (p=0.02), and carbohydrate loading by 74% (p=0.02). Intra-operatively, compliance with use of short-acting anesthetics increased by 37% (p=0.01) and avoidance of abdominal drainage increased by 7% (p=0.04). Use of goal-directed fluid therapy decreased by 16% (p=0.04). Post-operatively, there was increased compliance with avoiding salt and water overload (8%, p=0.02) and multimodal analgesia (5%, p=0.02).Conclusions Over the time period of the study, overall compliance increased from 69.7% to 75.8%. Compliance (≥80%) with ERAS is associated with lower complication rates, fewer 30-day re-admissions, and shorter length of stay without impacting re-operation rates and post-operative opioid use.All data relevant to the study are included in the article or uploaded as supplementary information.