Obstetrics and gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Obstetrics, gynecology and reproductive biology, Harvard Medical School, Boston, Massachusetts, USA.
Int J Gynecol Cancer. 2020 Jan;30(1):122-127. doi: 10.1136/ijgc-2019-000848. Epub 2019 Nov 25.
Enhanced recovery after surgery (ERAS) pathways combine a comprehensive set of peri-operative practices that have been demonstrated to hasten patient post-operative recovery. We aimed to evaluate the adoption of ERAS components and assess attitudes towards ERAS among gynecologic oncologists.
We developed and administered a cross-sectional survey of attending, fellow, and resident physicians who were members of the Society of Gynecologic Oncology in January 2018. The χ test was used to compare adherence to individual components of ERAS.
There was a 23% survey response rate and we analyzed 289 responses: 79% were attending physicians, 57% were from academic institutions, and 64% were from institutions with an established ERAS pathway. Respondents from ERAS institutions were significantly more likely to adhere to recommendations regarding pre-operative fasting for liquids (ERAS 51%, non-ERAS 28%; p<0.001), carbohydrate loading (63% vs 16%; p<0.001), intra-operative fluid management (78% vs 32%; p<0.001), and extended duration of deep vein thrombosis prophylaxis for malignancy (69% vs 55%; p=0.003). We found no difference in the use of mechanical bowel preparation, use of peritoneal drainage, or use of nasogastric tubes between ERAS and non-ERAS institutions. Nearly all respondents (92%) felt that ERAS pathways were safe.
Practicing at an institution with an ERAS pathway increased adoption of many ERAS elements; however, adherence to certain guidelines remains highly variable. Use of bowel preparation, nasogastric tubes, and peritoneal drainage catheters remain common. Future work should identify barriers to the implementation of ERAS and its components.
术后加速康复（ERAS）路径结合了一系列围手术期实践，这些实践已被证明可以加速患者术后康复。我们旨在评估 ERAS 成分的采用情况，并评估妇科肿瘤学家对 ERAS 的态度。
我们于 2018 年 1 月开发并向 Society of Gynecologic Oncology 的主治医生、研究员和住院医师进行了横断面调查。使用 χ 检验比较 ERAS 各个成分的依从性。
调查的回应率为 23%，我们分析了 289 份回复：79%是主治医生，57%来自学术机构，64%来自建立了 ERAS 路径的机构。来自 ERAS 机构的受访者更有可能遵守关于术前禁食液体（ERAS 51%，非 ERAS 28%；p<0.001）、碳水化合物负荷（63%比 16%；p<0.001）、术中液体管理（78%比 32%；p<0.001）以及延长恶性肿瘤深静脉血栓形成预防时间（69%比 55%；p=0.003）的建议。我们发现 ERAS 和非 ERAS 机构之间在使用机械性肠道准备、使用腹膜引流和使用鼻胃管方面没有差异。几乎所有受访者（92%）认为 ERAS 路径是安全的。
在具有 ERAS 路径的机构中执业增加了许多 ERAS 元素的采用；然而，某些指南的依从性仍然高度可变。使用肠道准备、鼻胃管和腹膜引流管仍然很常见。未来的工作应该确定实施 ERAS 及其成分的障碍。
