The Canadian Gynaecologic Oncology Perioperative Management Survey: Baseline Practice Prior to Implementation of Enhanced Recovery After Surgery (ERAS) Society Guidelines

Objective: To survey the current practice of Society of Gynecologic Oncology of Canada (GOC) members about preoperative, intraoperative, and postoperative phases of care. The survey was carried out prior to publication of the Enhanced Recovery After Surgery (ERAS) Society gynaecologic/oncology guidelines.

Methods: A survey was developed by the GOC and distributed to all surgical members between September and December 2015.

Results: The survey was completed by 77 of 92 practising gynaecologic oncologists (84%), representing 19 centres in 16 cities across Canada. Only 14.3% of respondents counselled their patients to stop smoking and drinking four weeks before surgery, while 41.6% routinely counselled patients to stop taking oral contraceptive pills. Approximately half of respondents (44.7%) prescribed preoperative mechanical bowel preparation. Over two thirds (67.5%) asked their patients not to eat solid foods after midnight on the day of surgery, and 19.5% recommended carbohydrate loading. Venous thromboembolism prophylaxis was given prior to laparotomy by 85.7% of participants overall, and by 67.6% prior to laparoscopy. The majority of respondents did not routinely use nasogastric tubes or intra-abdominal drains. The preferred modality for postoperative pain control after laparotomy was patient-controlled analgesia with narcotics (66.2%); only 29.9% chose epidural analgesia. Over half of respondents (56.6%) prescribed a progressive diet after surgery, while 42.1% recommended starting on an immediate standard diet postoperatively.

Conclusion: The responses to this survey show wide variations in practice in the perioperative phases of surgical care. Implementation of the ERAS Society gynaecologic/oncology guidelines should help integrate evidence-based knowledge into practice, align perioperative care, and minimize practice variations, resulting in improved outcomes for patients.