Enhanced recovery after surgery (ERAS) protocols for gynecologic (GYN) surgery are increasingly being reported and may be associated with superior outcomes, reduced length of hospital stay, and cost savings. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery, which is a nationwide initiative to disseminate best practices in perioperative care to more than 750 hospitals across five major surgical service lines in a 5-year period. The program is designed to identify evidence-based process measures shown to prevent healthcare-associated conditions and hasten recovery after surgery, integrate those into a comprehensive service line-based pathway, and assist hospitals in program implementation. In conjunction with this effort, we have conducted an evidence review of the various anesthesia components which may influence outcomes and facilitate recovery after GYN surgery. A literature search was performed for each intervention, and the highest levels of available evidence were considered. Anesthesiology-related interventions for preoperative (carbohydrate loading/fasting, multimodal preanesthetic medications), intraoperative (standardized intraoperative pathway, regional anesthesia, protective ventilation strategies, fluid minimization) and postoperative (multimodal analgesia) phases of care are included. We have summarized the best available evidence to recommend the anesthetic components of care for ERAS for GYN surgery.
- fast-track surgery
- enhanced recovery after surgery
- enhanced recovery pathway
- patient safety
- perioperative care
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Contributors MCG, MMG, CYK, ECW, CLW: conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. MC, MJS: analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content.
Funding This project was funded under contract number HHSP233201500020I by the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the US Department of Health and Human Services.
Competing interests CYK, ECW, and CLW receive salary support through a contract with the AHRQ (HHSP233201500020I). MMG receives a consultant fee through a contract with the AHRQ (HHSP233201500020I). MC is a consultant for Edwards Lifesciences, Masimo, and Medtronic, and is the founder of Sironis. He receives research support from Edwards Lifesciences, Masimo, and the NIH (R01 GM117622, R01 NR013912).
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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