The Canadian Gynecologic Oncology Peri-operative Management Survey: re-examining Enhanced Recovery After Surgery (ERAS) recommendations

Alon D Altman; Alexandre Rozenholc; Lana Saciragic; Xiao-Qing Liu; Gregg Nelson; Society of Gynecologic Oncology of Canada (GOC) Community of Practice in ERAS

doi:10.1136/ijgc-2022-003562

The Canadian Gynecologic Oncology Peri-operative Management Survey: re-examining Enhanced Recovery After Surgery (ERAS) recommendations

Int J Gynecol Cancer. 2022 Jun 24:ijgc-2022-003562. doi: 10.1136/ijgc-2022-003562. Online ahead of print.

Authors

Alon D Altman^{1

2}, Alexandre Rozenholc³, Lana Saciragic⁴, Xiao-Qing Liu⁵, Gregg Nelson⁶; Society of Gynecologic Oncology of Canada (GOC) Community of Practice in ERAS

Affiliations

¹ Gynecologic Oncology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada alondaltman@gmail.com.
² CancerCareManitoba, Research Institute in Oncology and Hematology, Winnipeg, Manitoba, Canada.
³ Gynecologic Oncology Service; Obstetrics and Gynecology Service, Hopital de Gatineau, Gatineau, Quebec, Canada.
⁴ Gynecologic Oncology, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.
⁵ Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶ Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada.

PMID: 35750353
DOI: 10.1136/ijgc-2022-003562

Abstract

Objective: Enhanced Recovery After Surgery (ERAS) is a global surgery quality improvement program associated with improved clinical outcomes across the spectrum of disciplines, including gynecologic oncology. The objective of this study was to re-survey the practice of ERAS Gynecologic Oncology guidelines across Canada, after the initial guidelines publication (2016), subsequent guidelines update (2019), and Society of Gynecologic Oncology of Canada (GOC) education events.

Methods: A survey was created and developed through the GOC Communities of Practice ERAS section and distributed to all members between March and November 2021. The results of this survey were compared with the survey performed in 2015 RESULTS: The initial GOC survey in 2015 included 77/92 active gynecologic oncologists (84%) representing all provinces in Canada. The current updated survey had responses from 59/118 active gynecologic oncologists (51%) also from every province. Compared with the original survey there was a statistically significant improvement in uptake of 10 ERAS recommendations: smoking/alcohol cessation, modern fasting guidelines (allowance of clear fluids and solid food pre-operatively), carbohydrate loading, pre-operative warming, early feeding, post-operative laxative use, avoidance of nasogastric tubes and abdominal drains, foley catheter removal at 6 hours, and active mobilization (all p<0.003). Only two fields (stopping oral contraceptive medications pre-operatively and foley catheter removal post-operative day 1) showed worsening uptake across the two surveys (p<0.01). The ERAS recommendations that did not change in the examined time frame included routine use of mechanical bowel preparation, venous thromboembolism prophylaxis, pre-operative antibiotics, and additional antibiotic dosing for prolonged surgery.

Conclusions: This survey demonstrates increased uptake of 10 of the ERAS guideline recommendations among Canadian gynecologic oncology providers. These findings may translate to improvements in clinical outcomes and healthcare system-level benefits including increased hospital capacity and cost savings.

Keywords: gynecologic surgical procedures; postoperative care; preoperative care; surgery.