Enhanced Recovery after Surgery (ERAS) Practices in Minimally Invasive Gynecologic Surgery: A National Survey

Abstract

<h3>Study Objective</h3> Enhanced Recovery After Surgery (ERAS) pathways are evidence-based practices aimed at minimizing perioperative physiologic stress responses. This reduces recovery time, hospital-stay length, postoperative complications, and hospital cost per patient. The objective of this study was to assess the Canadian application of and adherence to ERAS protocols during minimally invasive gynecologic surgery. We also aimed to identify facilitators and barriers to ERAS uptake in our population. <h3>Design</h3> A self-administered cross-sectional survey was distributed via three listservs (Canadian Ob/Gyn residency programs, CanSAGE, and the Society of Obstetricians and Gynecologists of Canada [SOGC]) between February 2021 to January 2022. The survey assessed 14 perioperative components as per the American Association of Gynecologic Laparoscopists (AAGL) ERAS consensus guidelines. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Canadian Ob/Gyn residents, fellows, and attendings. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> 157 responses were analyzed. Majority of respondents (77%) are attendings and work in academic hospitals (48%). Only 41% of respondents work within an established ERAS program. Majority of respondents engage in preoperative anemia optimization, although targets varied with 43% targeting Hemoglobin>120g/L. The proportion of respondents that engaged in other preoperative interventions (e.g., lifestyle modification) varied. While most counselled on hyperglycemia and obstructive sleep apnea, a smaller proportion (16-39%) addressed obesity, smoking cessation, and alcohol intake; notably, this was consistent across sites with and without established ERAS programs. Respondents had a high adherence to intraoperative practices including VTE prophylaxis (83%), early feeding (98%), and early ambulation (89%). There was poor adherence to perioperative fasting times, preoperative carbohydrate loading, and intraoperative IV fluids. Most respondents felt ERAS pathways were safe (98%) and improved patient outcomes (82%). <h3>Conclusion</h3> While the implementation of formal ERAS pathways differs between provinces and hospitals, practitioners engage in various ERAS components as per consensus guidelines. Future and targeted research around ERAS components with lower adherence would be beneficial in identifying and addressing barriers to optimize surgical care.