Implementation of the ERAS protocol in gynecology and oncogynecology – evaluation of a pilot study

Česká verze

Authors: Tomáš Brtnický ¹ ; Markéta Malecová ¹ ; Peter Koliba ¹ ; P. Hubka ¹ ; P. Sládková ² ; D. Hodyc ³; M. Škodová ³; Michal Zikán ¹
Authors place of work: Gynekologicko-porodnická klinika 1. LF UK a FN Bulovka, Praha ¹; Oddělení fyziatrie a léčebné rehabilitace, FN Bulovka, Praha ²; Advance Hospital Analytics, Praha ³
Published in the journal: Ceska Gynekol 2023; 88(5): 347-352
Category: Původní práce
doi: https://doi.org/10.48095/cccg2023347

Summary

Objective: To describe the implementation process and evaluate the success of compliance with the recommended ERAS protocol in the Czech healthcare system. Methods: The study included 163 patients from March to September 2022, a total of 7 months. Patients were divided into three groups according to the type of surgery. Clinical protocol: Oncogynecology, hysterectomy and laparoscopy. The implementation was realized in three phases (preparation, implementation of the protocol itself and evaluation). Results and conclusions: The cumulative adherence rate was 90% or more in all three groups. Based on the pilot results at our department, we evaluated the ERAS concept as a well-implemented tool for gynaecological departments in the Czech healthcare system.

Keywords:

ERAS – adherence – implementation

Zdroje

1. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 1999; 86 (2): 227–230. doi: 10.1046/j.1365-2168.1999. 01023.x.

2. Nelson G, Altman AD, Nick A et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations – Part I. Gynecol Oncol 2016; 140 (2): 313–322. doi: 10.1016/j.ygyno.2015.11.015.

3. Nelson G, Altman AD, Nick A et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS^®) Society recommendations – Part II. Gynecol Oncol 2016; 140 (2): 323–332. doi: 10.1016/j.ygyno.2015.12.019.

4. Nelson G, Bakkum-Gamez J, Kalogera E et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations – 2019 update. Int J Gynecol Cancer 2019; 29 (4): 651–668. doi: 10.1136/ijgc-2019-000 356.

5. Brown ML, Simpson V, Clark AB et al. ERAS implementation in an urban patient population undergoing gynecologic surgery. Best Pract Res Clin Obstet Gynaecol 2022; 85 (Pt B): 1–11. doi: 10.1016/j.bpobgyn.2022.07.009.

6. Pisarska M, Pędziwiatr M, Małczak P et al. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Int J Surg 2016; 36 (Pt A): 377–382. doi: 10.1016/j.ijsu.2016.11. 088.

7. Gustafsson UO, Oppelstrup H, Thorell A et al. Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery: a retrospective cohort study. World J Surg 2016; 40 (7): 1741–1747. doi: 10.1007/s00268-016-3460-y.

8. Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg 2017; 39: 156–162. doi: 10.1016/j.ijsu.2017.01.111.

9. Schneider S, Armbrust R, Spies C et al. Prehabilitation programs and ERAS protocols in gynecological oncology: a comprehensive review. Arch Gynecol Obstet 2020; 301 (2): 315–326. doi: 10.1007/s00404-019-05321-7.

10. Kehlet H, Joshi GP. Enhanced Recovery After Surgery: current controversies and concerns. Anesth Analg 2017; 125 (6): 2154–2155. doi: 10.1213/ANE.0000000000002231.

11. Kehlet H. Enhanced Recovery After Surgery (ERAS): good for now, but what about the future? Can J Anaesth 2015; 62 (2): 99–104. doi: 10.1007/s12630-014-0261-3.

12. Kocián P, Whitley A, Přikryl P et al. Enhanced recovery after colorectal surgery: the clinical and economic benefit in elderly patients. Eur Surg 2019; 51: 183–188. doi: 10.1007/s103 53-019-0595-8.