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Enhanced Recovery after Surgery (ERAS) in Gynecologic Surgery—A Review

  • Minimally Invasive Gynecologic Surgery (A Yunker, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to summarize the newly published guidelines on enhanced recovery after surgery (ERAS) in gynecologic oncology and discuss recent studies evaluating the outcomes of ERAS implementation in general gynecology and gynecologic oncology.

Recent Findings

ERAS guidelines for gynecologic surgery include preoperative diet, preoperative education, multimodal analgesia, early postoperative feeding, early mobilization and urinary catheter removal, avoidance of mechanical bowel preparation and drains, maintenance of normothermia, and minimal fluid shifts. The studies evaluated in this update include mostly retrospective observational studies and few randomized controlled trials. The primary outcome of the majority of studies, length of stay, was found to be less after ERAS implementation than prior to implementation. Secondary outcomes such as rates of readmission, mortality, and postoperative complications yielded mixed results; however, most differences were not statistically significant. Hospital costs also decreased after ERAS implementation, but the cost differences were only statistically significant in half of the studies with a single dissenting study.

Summary

Implementation of ERAS protocols in gynecologic surgery is becoming ubiquitous as more evidence demonstrates improved patient outcomes and decreased healthcare costs. However, the majority of studies evaluating the efficacy of ERAS protocols are retrospective studies. Now that a standardized set of enhanced recovery guidelines in gynecologic oncology have been published, more institutions will hopefully begin to implement ERAS programs. Future research should subsequently include prospective, randomized controlled trials to validate the benefits concluded from studies based on historical data.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Biology, Division of Gynecologic Oncology, Western Connecticut Health Network, 24 Hospital Avenue, Danbury, CT, 06810, USA

    Ashley Moon, Abhilasha Tangada, Vaagn Andikyan & Linus Chuang

  2. Department of Obstetrics and Gynecology, Larner College of Medicine, University of Vermont, Burlington, VT, USA

    Vaagn Andikyan & Linus Chuang

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  1. Ashley Moon
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  2. Abhilasha Tangada
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  3. Vaagn Andikyan
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Correspondence to Ashley Moon.

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A.M., A.T., V.A., and L.C. declare no conflict of interest.

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This article is part of the Topical Collection on Minimally Invasive Gynecologic Surgery

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Moon, A., Tangada, A., Andikyan, V. et al. Enhanced Recovery after Surgery (ERAS) in Gynecologic Surgery—A Review. Curr Obstet Gynecol Rep 7, 122–132 (2018). https://doi.org/10.1007/s13669-018-0247-1

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