Abstract
<h3>Objectives:</h3> To determine if adherence to enhanced recovery after surgery (ERAS) protocol decreases the time to adjuvant therapy in gynecologic oncology patients undergoing laparotomy. <h3>Methods:</h3> After implementation of an ERAS program based on published guidelines at a single academic institution, women were identified over a 12-month period who underwent a planned exploratory laparotomy for suspected gynecologic malignancy and met criteria for adjuvant treatment. Prior to initiation of the ERAS program, pre-ERAS patients were identified by ICD-10 diagnosis codes and CPT laparotomy codes over a two-year period. Patient data was collected including demographics, adherence to ERAS protocols, type of and time to adjuvant treatment. The two groups were compared by mean difference using odds ratio and relative risk with 95% confidence interval. <h3>Results:</h3> We identified 52 women in the post-ERAS cohort and 99 in the pre-ERAS cohort who met criteria. Patient characteristics including disease site, type of adjuvant treatment, ASA, BMI, and length of surgery were similar between groups. Approximately one half of the patients had ovarian cancer, 54.0% in pre-ERAS and 50.8% in post-ERAS. There was a similar rate of chemotherapy as adjuvant treatment, 76.5% in pre ERAS and 76.9% in post ERAS. A total of 25 ERAS protocol elements were audited, and 10 were included for this analysis. The mean difference in time to adjuvant treatment between the 2 groups was 5.6 days (95% confidence interval 29.3- 36.8). Ovarian cancer patients underwent adjuvant treatment 10 days earlier in the pre-ERAS group compared to the post-ERAS group (95% confidence interval 31.3-43.1). <h3>Conclusions:</h3> After implementation and adherence to ERAS protocols, gynecologic cancer patients undergoing laparotomy returned to adjuvant oncologic therapy quicker than a pre-ERAS cohort, with ovarian cancer patients achieving a 10-day improvement in time to adjuvant chemotherapy. The entire post-ERAS group met the goal of 42 days from surgery to adjuvant treatment set out by SGO and the Commission on Cancer as an evidence based quality metric. Overall, our study demonstrated that gynecologic oncology patients undergoing laparotomy reach their next step in cancer treatment faster than a pre-ERAS program.
Published Version
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