Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update

Abstract

Background: Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges.

Methods: Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.

Results: All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly.

Conclusions: The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.

Keywords: ERAS; Enhanced recovery after surgery; Gynecologic oncology surgery; Perioperative care; Surgical quality.

Conflict of interest statement

Declaration of Competing Interest Dr. Nelson reports personal fees from AstraZeneca, outside the submitted work. He is the Treasurer of the ERAS® Society and Co-Chair of Enhanced Recovery Canada™. Dr. Fotopoulou reports personal fees from Roche, AstraZeneca, MSD, Clovis, Tesaro, GSK, Ethicon; all outside the submitted work. Dr. Taylor reports no conflicts to declare. Dr. Glaser reports no conflicts to declare. Dr. Bakkum-Gamez reports no conflicts to declare. Dr. Meyer reports research funding from AstraZeneca, personal fees from GSK, stocks in Crispr, Invitae, Denali, and Bristol Myers Squibb; all outside the submitted work. Dr. Stone reports research consulting for AstraZeneca, research funding from Pacira, personal fees from AstraZeneca, GSK; all outside the submitted work. Dr. Mena reports research funding from Pacira, outside the submitted work. Dr. Elias reports no conflicts to declare. Dr. Altman reports research funding from Merck, AstraZeneca, Clovis, Pfizer, and personal fees from GSK, AstraZeneca, Merck; all outside the submitted work. Dr. Bisch reports research funding from Pharmacosmos, Pfizer and personal fees from Merck, Johnson & Johnson, Ethicon; all outside the submitted work. Dr. Ramirez reports no conflicts to declare. Dr. Dowdy reports no conflicts to declare.

Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.