Updates in Enhanced Recovery Pathways for Gynecologic Surgery


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        • Oliphant S.S.
        • Jones K.A.
        • Wang L.
        • et al.
        Trends over time with commonly performed obstetric and gynecologic inpatient procedures.
        Obstet Gynecol. 2010; 116: 926-931
        • Miralpeix E.
        • Nick A.M.
        • Meyer L.A.
        • et al.
        A call for new standard of care in perioperative gynecologic oncology practice: impact of enhanced recovery after surgery (ERAS) programs.
        Gynecol Oncol. 2016; 141: 371-378
        • Ljungqvist O.
        • Scott M.
        • Fearon K.C.
        Enhanced recovery after surgery: a review.
        JAMA Surg. 2017; 152: 292-298
        • Altman A.D.
        • Helpman L.
        • McGee J.
        • et al.
        Enhanced recovery after surgery: implementing a new standard of surgical care.
        CMAJ. 2019; 191: E469-E475
        • Nelson G.
        • Kalogera E.
        • Dowdy S.C.
        Enhanced recovery pathways in gynecologic oncology.
        Gynecol Oncol. 2014; 135: 586-594
        • Committee on Gynecologic P
        ACOG committee opinion no. 750: perioperative pathways: enhanced recovery after surgery.
        Obstet Gynecol. 2018; 132: e120-e130
        • Pache B.
        • Joliat G.R.
        • Hubner M.
        • et al.
        Cost-analysis of enhanced recovery after surgery (ERAS) program in gynecologic surgery.
        Gynecol Oncol. 2019; 154: 388-393
        • Harrison R.F.
        • Li Y.
        • Guzman A.
        • et al.
        Impact of implementation of an enhanced recovery program in gynecologic surgery on healthcare costs.
        Am J Obstet Gynecol. 2020; 222: 66.e1-66.e9
        • Meyer L.A.
        • Lasala J.
        • Iniesta M.D.
        • et al.
        Effect of an enhanced recovery after surgery program on opioid use and patient-reported outcomes.
        Obstet Gynecol. 2018; 132: 281-290
        • Marcus R.K.
        • Lillemoe H.A.
        • Rice D.C.
        • et al.
        Determining the safety and efficacy of enhanced recovery protocols in major oncologic surgery: an institutional NSQIP analysis.
        Ann Surg Oncol. 2019; 26: 782-790
        • Nelson G.
        • Bakkum-Gamez J.
        • Kalogera E.
        • et al.
        Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery after Surgery (ERAS) Society recommendations—2019 update.
        Int J Gynecol Cancer. 2019; 29: 651-668
        • Nelson G.
        • Altman A.D.
        • Nick A.
        • et al.
        Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery after Surgery (ERAS(R)) Society recommendations--part I.
        Gynecol Oncol. 2016; 140: 313-322
        • Nelson G.
        • Altman A.D.
        • Nick A.
        • et al.
        Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery after Surgery (ERAS(R)) Society recommendations--part II.
        Gynecol Oncol. 2016; 140: 323-332
        • Bauchat J.R.
        • Habib A.S.
        Evidence-based anesthesia for major gynecologic surgery.
        Anesthesiol Clin. 2015; 33: 173-207
        • Elias K.M.
        • Stone A.B.
        • McGinigle K.
        • et al.
        The reporting on ERAS compliance, outcomes, and elements research (recover) checklist: a joint statement by the ERAS((R)) and ERAS((R)) USA societies.
        World J Surg. 2019; 43: 1-8
        • Altman A.D.
        • Nelson G.S.
        Society of Gynecologic Oncology of Canada Annual General Meeting CPD, Communities of Practice Education C. The Canadian Gynaecologic Oncology Perioperative Management survey: baseline practice prior to implementation of Enhanced Recovery After Surgery (ERAS) Society guidelines.
        J Obstet Gynaecol Can. 2016; 38: 1105-1109.e2
        • Modesitt S.C.
        • Sarosiek B.M.
        • Trowbridge E.R.
        • et al.
        Enhanced recovery implementation in major gynecologic surgeries: effect of care standardization.
        Obstet Gynecol. 2016; 128: 457-466
        • Jarrell J.
        • Robert M.
        • Giamberardino M.A.
        • et al.
        Pain, psychosocial tests, pain sensitization and laparoscopic pelvic surgery.
        Scand J Pain. 2018; 18: 49-57
        • Nelson G.
        • Dowdy S.C.
        • Lasala J.
        • et al.
        Enhanced recovery after surgery (ERAS(R)) in gynecologic oncology - practical considerations for program development.
        Gynecol Oncol. 2017; 147: 617-620
        • Simon N.V.
        • Heaps K.P.
        • Chodroff C.H.
        Improving the processes of care and outcomes in obstetrics/gynecology.
        Jt Comm J Qual Improv. 1997; 23: 485-497
        • de Groot J.J.
        • Maessen J.M.
        • Slangen B.F.
        • et al.
        A stepped strategy that aims at the nationwide implementation of the enhanced recovery after surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial.
        Implement Sci. 2015; 10: 106
        • de Groot J.J.
        • van Es L.E.
        • Maessen J.M.
        • et al.
        Diffusion of enhanced recovery principles in gynecologic oncology surgery: is active implementation still necessary?.
        Gynecol Oncol. 2014; 134: 570-575
        • Iniesta M.D.
        • Lasala J.
        • Mena G.
        • et al.
        Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery.
        Int J Gynecol Cancer. 2019; 29: 1417-1424
        • Wijk L.
        • Udumyan R.
        • Pache B.
        • et al.
        International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery.
        Am J Obstet Gynecol. 2019; 221: 237.e1-237.e11
        • Bisch S.P.
        • Wells T.
        • Gramlich L.
        • et al.
        Enhanced recovery after surgery (ERAS) in gynecologic oncology: system-wide implementation and audit leads to improved value and patient outcomes.
        Gynecol Oncol. 2018; 151: 117-123
        • Gan T.J.T.J.
        • Miller T.E.
        • Scott M.J.
        • et al.
        Enhanced recovery for major abdominopelvic surgery.
        NY Professional Communications, West Islip (NY)2016
        • de Groot J.J.
        • Ament S.M.
        • Maessen J.M.
        • et al.
        Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis.
        Acta Obstet Gynecol Scand. 2016; 95: 382-395
        • Burgos R.
        • Sanchez-Iglesias J.L.
        • Cardenas G.
        • et al.
        Mon-p240: enhanced recovery after surgery protocol (ERAS) for advanced gynecological cancer. Preliminary results.
        Clin Nutr. 2016; 35: S241
        • Lashkul O.S.
        • Gavrylyuk V.P.
        • Pavelko N.O.
        Fast track surgery - multimodal strategy of postoperative period management in gynecological patients. The role of anesthesiologists.
        Clin Anesthesiology Intensive Care. 2017; 1: 21-28
        • Dickson E.L.
        • Stockwell E.
        • Geller M.A.
        • et al.
        Enhanced recovery program and length of stay after laparotomy on a gynecologic oncology service: a randomized controlled trial.
        Obstet Gynecol. 2017; 129: 355-362
        • Antypin E.
        • Uvarov D.
        • Antypina N.
        • et al.
        Effect of enhanced recovery after surgery (ERAS) on secretion of pro-inflammatory cytokines and C-reactive protein after hysterectomy.
        Eur J Anesthesiology. 2013; 30: 13
        • Bourazani M.
        • Karopoulou E.
        • Fyrfiris N.
        Ep1096 Implementing enhanced recovery after surgery (ERAS) pathways in major gynecologic oncology operations in Greece (the pre-eliminary results of our department).
        Int J Gynecol Cancer. 2019; 29: A573-A574
        • Ferrari F.
        • Forte S.
        • Sbalzer N.
        Validation of an ERAS protocol in gynecological surgery: interim analysis of an Italian randomized controlled trial.
        Int J Gynecol Cancer. 2019; 29: A40
        • Sánchez-Iglesias J.
        • Carbonell Socias M.
        • Pérez Benavente A.
        • et al.
        Enhanced recovery after surgery in advanced ovarian cancer: a prospective randomized trial.
        Int J Gynecol Cancer. 2019; 29: A33
        • Johnson K.
        • Razo S.
        • Smith J.
        • et al.
        Optimize patient outcomes among females undergoing gynecological surgery: a randomized controlled trial.
        Appl Nurs Res. 2019; 45: 39-44
        • Yi H.C.
        • Ibrahim Z.
        • Abu Zaid Z.
        • et al.
        Impact of enhanced recovery after surgery with preoperative whey protein-infused carbohydrate loading and postoperative early oral feeding among surgical gynecologic cancer patients: an open-labelled randomized controlled trial.
        Nutrients. 2020; 12: 264
        • Pallett A.C.
        • Nguyen B.T.
        • Klein N.M.
        • et al.
        A randomized controlled trial to determine whether a video presentation improves informed consent for hysterectomy.
        Am J Obstet Gynecol. 2018; 219: 277.e1-277.e7
        • Schenker Y.
        • Fernandez A.
        • Sudore R.
        • et al.
        Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review.
        Med Decis Making. 2011; 31: 151-173
        • Chan J.L.
        • Letourneau J.
        • Salem W.
        • et al.
        Regret around fertility choices is decreased with pre-treatment counseling in gynecologic cancer patients.
        J Cancer Surviv. 2017; 11: 58-63
        • Dolmans M.M.
        Recent advances in fertility preservation and counseling for female cancer patients.
        Expert Rev Anticancer Ther. 2018; 18: 115-120
        • Kalogera E.
        • Dowdy S.
        Prehabilitation: enhancing the enhanced recovery after surgery pathway.
        Int J Gynecol Cancer. 2019; 29: 1233-1234
        • McLennan E.
        • Oliphant R.
        • Moug S.J.
        Limited preoperative physical capacity continues to be associated with poor postoperative outcomes within a colorectal ERAS programme.
        Ann R Coll Surg Engl. 2019; 101: 261-267
        • Miralpeix E.
        • Mancebo G.
        • Gayete S.
        • et al.
        Role and impact of multimodal prehabilitation for gynecologic oncology patients in an enhanced recovery after surgery (ERAS) program.
        Int J Gynecol Cancer. 2019; 29: 1235-1243
        • Bisch S.
        • Nelson G.
        • Altman A.
        Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology.
        Nutrients. 2019; 11: 1088
        • Sanusi R.S.
        Outcome of combined neoadjuvant chemotherapy and vitamin a in advanced cervical carcinoma: a randomized double-blind clinical trial.
        Asian Pac J Cancer Prev. 2019; 20: 2213-2218
      1. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration.
        Anesthesiology. 2017; 126: 376-393
        • Lindemann K.
        • Kok P.S.
        • Stockler M.
        • et al.
        Enhanced recovery after surgery for advanced ovarian cancer: a systematic review of interventions trialed.
        Int J Gynecol Cancer. 2017; 27: 1274-1282
        • Xu C.
        • Peng J.
        • Liu S.
        • et al.
        Effect of chewing gum on gastrointestinal function after gynecological surgery: a systematic literature review and meta-analysis.
        J Obstet Gynaecol Res. 2018; 44: 936-943
        • Terzioglu F.
        • Simsek S.
        • Karaca K.
        • et al.
        Multimodal interventions (chewing gum, early oral hydration and early mobilisation) on the intestinal motility following abdominal gynaecologic surgery.
        J Clin Nurs. 2013; 22: 1917-1925
        • Hopkins L.
        • Brown-Broderick J.
        • Hearn J.
        • et al.
        Implementation of a referral to discharge glycemic control initiative for reduction of surgical site infections in gynecologic oncology patients.
        Gynecol Oncol. 2017; 146: 228-233
        • Al-Niaimi A.N.
        • Ahmed M.
        • Burish N.
        • et al.
        Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients.
        Gynecol Oncol. 2015; 136: 71-76
        • Galaal K.
        • Donkers H.
        • Bryant A.
        • et al.
        Laparoscopy versus laparotomy for the management of early stage endometrial cancer.
        Cochrane Database Syst Rev. 2018; 10: CD006655
        • Wang Y.Z.
        • Deng L.
        • Xu H.C.
        • et al.
        Laparoscopy versus laparotomy for the management of early stage cervical cancer.
        BMC Cancer. 2015; 15: 928
        • Lawrie T.A.
        • Liu H.
        • Lu D.
        • et al.
        Robot-assisted surgery in gynaecology.
        Cochrane Database Syst Rev. 2019; 4: CD011422
        • Miller T.E.
        • Roche A.M.
        • Mythen M.
        Fluid management and goal-directed therapy as an adjunct to enhanced recovery after surgery (ERAS).
        Can J Anaesth. 2015; 62: 158-168
        • Michard F.
        The burden of high-risk surgery and the potential benefit of goal-directed strategies.
        Crit Care. 2011; 15: 447
        • Pearse R.
        • Dawson D.
        • Fawcett J.
        • et al.
        Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445].
        Crit Care. 2005; 9: R687-R693
      2. Bennett D, Chaloner E, Mythen M. Modernising care for Patients Undergoing Major Surgery: Improving Patient Outcomes and Increasing Clinical Efficiency. A Report by the Improving Surgical Outcomes Group. 2005.

        • Rollins K.E.
        • Lobo D.N.
        Intraoperative goal-directed fluid therapy in elective major abdominal surgery: a meta-analysis of randomized controlled trials.
        Ann Surg. 2016; 263: 465-476
        • Koerner C.P.
        • Lopez-Aguiar A.G.
        • Zaidi M.
        • et al.
        Caution: increased acute kidney injury in enhanced recovery after surgery (ERAS) protocols.
        Am Surg. 2019; 85: 156-161
        • Patel K.
        • Foster N.R.
        • Kumar A.
        • et al.
        Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival.
        Support Care Cancer. 2015; 23: 1303-1309
        • Lin W.L.
        • Lee M.S.
        • Wong C.S.
        • et al.
        Effects of intraoperative propofol-based total intravenous anesthesia on postoperative pain in spine surgery: comparison with desflurane anesthesia - a randomised trial.
        Medicine (Baltimore). 2019; 98: e15074
        • Munro A.
        • Sjaus A.
        • George R.B.
        Anesthesia and analgesia for gynecological surgery.
        Curr Opin Anaesthesiol. 2018; 31: 274-279
        • Popping D.M.
        • Elia N.
        • Van Aken H.K.
        • et al.
        Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials.
        Ann Surg. 2014; 259: 1056-1067
        • Uppal V.
        • Retter S.
        • Casey M.
        • et al.
        Efficacy of intrathecal fentanyl for cesarean delivery: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.
        Anesth Analg. 2020; 130: 111-125
        • Huepenbecker S.P.
        • Cusworth S.E.
        • Kuroki L.M.
        • et al.
        Continuous epidural infusion in gynecologic oncology patients undergoing exploratory laparotomy: the new standard for decreased postoperative pain and opioid use.
        Gynecol Oncol. 2019; 153: 356-361
        • Lee C.
        • Song Y.K.
        • Jeong H.M.
        • et al.
        The effects of magnesium sulfate infiltration on perioperative opioid consumption and opioid-induced hyperalgesia in patients undergoing robot-assisted laparoscopic prostatectomy with remifentanil-based anesthesia.
        Korean J Anesthesiol. 2011; 61: 244-250
        • Sessler D.I.
        • Pei L.
        • Huang Y.
        • et al.
        Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial.
        Lancet. 2019; 394: 1807-1815
        • Henschke N.
        • Kamper S.J.
        • Maher C.G.
        The epidemiology and economic consequences of pain.
        Mayo Clin Proc. 2015; 90: 139-147
        • Cata J.P.
        • Lasala J.
        • Bugada D.
        Best practice in the administration of analgesia in postoncological surgery.
        Pain Manag. 2015; 5: 273-284
        • Grant M.C.
        • Gibbons M.M.
        • Ko C.Y.
        • et al.
        Evidence review conducted for the AHRQ Safety Program for improving surgical care and recovery: focus on anesthesiology for gynecologic surgery.
        Reg Anesth Pain Med. 2019;
        • Bacal V.
        • Rana U.
        • McIsaac D.I.
        • et al.
        Transversus abdominis plane block for post hysterectomy pain: a systematic review and meta-analysis.
        J Minim Invasive Gynecol. 2019; 26: 40-52
        • Yousef N.K.
        Quadratus lumborum block versus transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized prospective controlled trial.
        Anesth Essays Res. 2018; 12: 742-747
        • Soffin E.M.
        • Lee B.H.
        • Kumar K.K.
        • et al.
        The prescription opioid crisis: role of the anaesthesiologist in reducing opioid use and misuse.
        Br J Anaesth. 2019; 122: e198-e208
        • Johnson C.M.
        • Makai G.E.H.
        A systematic review of perioperative opioid management for minimally invasive hysterectomy.
        J Minim Invasive Gynecol. 2019; 26: 233-243
        • Hillman R.T.
        • Sanchez-Migallon A.
        • Meyer L.A.
        • et al.
        Patient characteristics and opioid use prior to discharge after open gynecologic surgery in an enhanced recovery after surgery (ERAS) program.
        Gynecol Oncol. 2019; 153: 604-609
        • Mark J.
        • Argentieri D.M.
        • Gutierrez C.A.
        • et al.
        Ultrarestrictive opioid prescription protocol for pain management after gynecologic and abdominal surgery.
        JAMA Netw Open. 2018; 1: e185452
        • Yoong W.
        • Sivashanmugarajan V.
        • Relph S.
        • et al.
        Can enhanced recovery pathways improve outcomes of vaginal hysterectomy? Cohort control study.
        J Minim Invasive Gynecol. 2014; 21: 83-89
        • Sandberg E.M.
        • Twijnstra A.R.H.
        • Driessen S.R.C.
        • et al.
        Total laparoscopic hysterectomy versus vaginal hysterectomy: a systematic review and meta-analysis.
        J Minim Invasive Gynecol. 2017; 24: 206-217.e2
        • Gong R.
        • Hu Q.
        • Liu D.
        • et al.
        Enhanced recovery after surgery versus traditional care in total pelvic floor reconstruction surgery with transvaginal mesh.
        Int J Gynaecol Obstet. 2020; 148: 107-112
        • Carter-Brooks C.M.
        • Du A.L.
        • Ruppert K.M.
        • et al.
        Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway.
        Am J Obstet Gynecol. 2018; 219: 495.e1-495.e10
        • Ore A.S.
        • Shear M.A.
        • Liu F.W.
        • et al.
        Adoption of enhanced recovery after laparotomy in gynecologic oncology.
        Int J Gynecol Cancer. 2020; 30: 122-127
        • Kahokehr A.
        • Sammour T.
        • Zargar-Shoshtari K.
        • et al.
        Implementation of ERAS and how to overcome the barriers.
        Int J Surg. 2009; 7: 16-19
        • Funder J.A.
        • Tolstrup R.
        • Jepsen B.N.
        • et al.
        Postoperative paralytic ileus remains a problem following surgery for advanced pelvic cancers.
        J Surg Res. 2017; 218: 167-173