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AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery

International Urogynecology Journal volume 33, pages 2921–2940 (2022)Cite this article

Abstract

Introduction and hypothesis

Enhanced recovery after surgery (ERAS) evidence-based protocols for perioperative care can lead to improvements in clinical outcomes and cost savings. This article aims to present consensus recommendations for the optimal perioperative management of patients undergoing urogynecological surgery.

Methods

A review of meta-analyses, randomized clinical trials, large nonrandomized studies, and review articles was conducted via PubMed and other databases for ERAS and urogynecological surgery. ERAS protocol components were established, and then quality of the evidence was both graded and used to form consensus recommendations for each topic. These recommendations were developed and endorsed by the writing group, which is comprised of the American Urogynecologic Society and the International Urogynecological Association members.

Results

All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. The components of ERAS with a high level of evidence to support their use include fasting for 6 h and taking clear fluids up to 2 h preoperatively, euvolemia, normothermia, surgical site preparation, antibiotic and antithrombotic prophylaxis, strong antiemetics and dexamethasone to reduce postoperative nausea and vomiting, multimodal analgesia and restrictive use of opiates, use of chewing gum to reduce ileus, removal of catheter as soon as feasible after surgery and avoiding systematic use of drains/vaginal packs.

Conclusions

The evidence base and recommendations for a urogynecology-relevant ERAS perioperative care pathway are presented in this consensus review. There are several elements of ERAS with strong evidence of benefit in urogynecological surgery.

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Fig. 1

Abbreviations

AUGS:

American Urogynecologic Society

BMI:

Body mass index

ERAS:

Enhanced recovery after surgery

GRADE:

Grading of recommendations, assessment, development, and evaluation

FPMRS:

Female pelvic medicine and reconstructive surgery

IPC:

Intermittent pneumatic compression

IV:

Intravenous

IUGA:

International Urogynecological Association

NSAIDs:

Nonsteroidal anti-inflammatory drugs

POI:

Postoperative ileus

PONV:

Postoperative nausea/vomiting

RCT:

Randomized control trial

SBO:

Small bowel obstruction

SDD:

Same day discharge

SSI:

Surgical site infection

VTE:

Venous thromboembolism

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Acknowledgements

The following writing group members are being recognized for their contributions to this article: Writing Group Chair: Pallavi Latthe. IUGA Writing Group Members: Pallavi Latthe (Birmingham Women’s and Children’s NHS Foundation Trust and University of Birmingham, Birmingham, UK); Gisele Vissoci Marquini (Department of Gynecology, Federal University of Uberlândia/MG (UFU) and Federal University of São Paulo (UNIFESP), São Paulo, Brazil); Chahin Achtari (CHUV-UNIL, Lausanne, Switzerland); Jorge Haddad (Division at Clinics Hospital of University of São Paulo, São Paulo, Brazil). AUGS Writing Group Members: Joseph Panza (University of Rochester Medical Center, Rochester, NY, USA); Christopher J. Jankowski (Mayo Clinic, Rochester, MN, USA); Christine A. Heisler (Departments of Ob/Gyn and Urology, University of Wisconsin, Madison, WI, USA); Krista Reagan (MultiCare Health System, Tacoma, WA, USA); Lisa C. Hickman (Division of Female Pelvic Medicine and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA).

The authors acknowledge Leslie Christensen, librarian at UWSC, for carrying out the systematic searches and advice on methods, and Lauren Cavendish (AUGS liason) for advice on manuscript layout, content, and other advice.

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    Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society

    • Pallavi Latthe
    • , Joseph Panza
    • , Gisele Vissoci Marquini
    • , Christopher J. Jankowski
    • , Christine A. Heisler
    • , Chahin Achtari
    • , Krista Reagan
    • , Lisa C. Hickman
    •  & Jorge Haddad

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    The joint AUGS-IUGA guidelines are an educational aid to good clinical practice. They present recognized methods and techniques of clinical practice, based on published evidence, for consideration by urogynecologists and other relevant health professionals.

    The ultimate judgment regarding a particular clinical procedure or treatment plan must be made by the doctor or other attendant in the light of clinical data presented by the patient and the diagnostic and treatment options available. Departure from the local prescriptive protocols or guidelines should be fully documented in the patient’s case notes at the time the relevant decision is taken.

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    Individual writing group members are noted in the Acknowledgements section.

    This report is being published concurrently in Urogynecology and in International Urogynecology Journal. The report is identical except for minor stylistic and spelling differences in keeping with each journal’s style. Citations from any of the two journals can be used when citing this article.

    Correspondence: Pallavi Latthe, Birmingham Women’s and Children’s NHS Foundation Trust and University of Birmingham, Birmingham, UK. E-mail: platthe@nhs.net

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    Developed by the Joint Writing Group of the International Urogynecological Association and the American Urogynecologic Society. AUGS-IUGA Joint clinical consensus statement on enhanced recovery after urogynecologic surgery. Int Urogynecol J 33, 2921–2940 (2022). https://doi.org/10.1007/s00192-022-05223-4

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    Keywords

    • Enhanced recovery
    • Urogynecological surgery