Abstract
ObjectiveEnhanced recovery after surgery (ERAS) pathways are evidence-based practices that minimize perioperative physiologic stress, reducing postoperative complications and recovery time. This study assessed the Canadian application of, and adherence to, ERAS recommendations during minimally invasive gynaecologic surgery, and identified barriers to ERAS uptake. MethodsA self-administered cross-sectional survey was distributed to obstetrics and gynaecology residents, fellows, and attendings through three national listservs from February 2021 to January 2022. The survey assessed 14 perioperative components per the AAGL (American Association of Gynecologic Laparoscopists) ERAS consensus guidelines. Two study groups were defined—participants with vs. without an established ERAS program—and comparison analyses as well as inferential statistical tests were performed. Results158 responses were analyzed. 41.9% of respondents work in a centre with an ERAS program. Adherence to ERAS recommendations was high with engaging patients in the operative processes, changing equipment after a contaminated procedure, discontinuing urinary catheters, and initiating early postoperative mobilization. ERAS programing enhanced adherence to preoperative carbohydrate loading, intraoperative fluid management, normothermia, and bowel regimen adjuncts (P < 0.05). Despite ERAS programming, adherence to some recommendations—preoperative fasting, comorbidity optimisation—remained low. Most respondents felt that ERAS is safe (98%) and improves outcomes (82%). ConclusionWhile the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners across Canada engage in various ERAS components. ERAS program sites had higher adherence to some perioperative recommendations; however, some high-level evidence recommendations still have national adherence gaps. Targeted research around low-adherence components would help identify and address barriers to optimize surgical care.
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