加速康复外科（ERAS®）协会妇科肿瘤学指南：应对实施挑战——2023 年更新。

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

机构信息

Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.

出版信息

Gynecol Oncol. 2023 Jun;173:58-67. doi: 10.1016/j.ygyno.2023.04.009. Epub 2023 Apr 21.

DOI:10.1016/j.ygyno.2023.04.009

PMID:37086524

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.

摘要

背景

尽管有证据支持其使用，但许多增强术后恢复（ERAS）的建议仍然没有得到很好的遵循，ERAS 实施的障碍仍然存在。在这份第二版更新的 ERAS® Society 指南中，提出了妇科肿瘤手术中最佳围手术期护理的共识，特别强调了实施挑战。

方法

基于临床医生利益相关者小组确定的差距，确定了 9 个实施挑战主题进行审查。使用 Embase 和 PubMed 对出版物进行了数据库检索（2018-2023 年）。根据推荐评估、制定与评价（GRADE）系统，对每个主题的研究进行了选择，重点是荟萃分析、随机对照试验和大型前瞻性队列研究。然后，由国际小组根据现有最佳证据对这些研究进行审查和分级。