Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Int J Gynecol Cancer. 2023 Aug 7;33(8):1287-1294. doi: 10.1136/ijgc-2023-004356.
This study aimed to analyze the adherence to strategies to prevent post-operative nausea and vomiting after implementation of an enhanced recovery after surgery (ERAS) protocol for gynae-oncology patients. Patient-reported nausea before and after ERAS was also studied.
This prospective observational study included all patients undergoing laparotomy for a suspicious pelvic mass or confirmed advanced ovarian cancer before (pre-ERAS) and after the implementation of ERAS (post-ERAS) at Oslo University Hospital, Norway. Patients were a priori stratified according to the planned extent of surgery into two cohorts (Cohort 1: Surgery of advanced disease; Cohort 2: Surgery for a suspicious pelvic tumor). Clinical data including baseline characteristics and outcome data were prospectively collected.
A total of 439 patients were included, 243 pre-ERAS and 196 post-ERAS. At baseline, 27% of the patients reported any grade of nausea. In the post-ERAS cohort, statistically significantly more patients received double post-operative nausea and vomiting prophylaxis (64% pre-ERAS vs 84% post-ERAS, p<0.0001). There was no difference in the need for rescue medication (82% pre-ERAS vs 79% post-ERAS; p=0.17) and no statistically significant difference between pre- and post-ERAS or between the surgical cohorts in patient-reported nausea of any grade on day 2. Patients who reported none/mild nausea on day 2 had significantly less peri-operative fluid administered during surgery than those who reported moderate or severe nausea (median 12.5 mL/kg/hour vs 16.5 mL/kg/hour, p=0.045) but, in multivariable analysis, fluid management did not remain significantly associated with nausea.
Implementation of an ERAS protocol increased the adherence to post-operative nausea and vomiting prevention guidelines. Nausea, both before and after laparotomy, remains an unmet clinical need of gynae-oncology patients also in an ERAS program. Patient-reported outcome measures warrant further investigation in the evaluation of ERAS.
本研究旨在分析妇科肿瘤患者接受加速康复外科（ERAS）方案后预防术后恶心呕吐（PONV）的策略依从性，并研究 ERAS 前后患者报告的恶心情况。
本前瞻性观察研究纳入了挪威奥斯陆大学医院接受剖腹手术治疗疑似盆腔肿块或确诊晚期卵巢癌的所有患者，这些患者在实施 ERAS 前（ERAS 前）和实施 ERAS 后（ERAS 后）进行了分组。根据手术范围的计划，患者被预先分为两个队列（队列 1：晚期疾病手术；队列 2：疑似盆腔肿瘤手术）。前瞻性收集了包括基线特征和结局数据在内的临床数据。
共纳入 439 例患者，其中 ERAS 前组 243 例，ERAS 后组 196 例。基线时，27%的患者报告有任何程度的恶心。在 ERAS 后组中，接受双重术后恶心呕吐预防的患者比例显著增加（64% ERAS 前 vs 84% ERAS 后，p<0.0001）。需要解救药物的情况在 ERAS 前组和 ERAS 后组之间没有差异（82% ERAS 前 vs 79% ERAS 后；p=0.17），在两个手术队列之间以及在患者报告的任何程度的恶心方面，在第 2 天也没有统计学上的差异。报告第 2 天无/轻度恶心的患者术中接受的围手术期液体量明显少于报告中度或重度恶心的患者（中位数 12.5 mL/kg/hour vs 16.5 mL/kg/hour，p=0.045），但在多变量分析中，液体管理与恶心之间没有显著关联。
ERAS 方案的实施增加了对术后恶心呕吐预防指南的依从性。在 ERAS 方案中，妇科肿瘤患者在剖腹手术后仍存在未满足的恶心临床需求。患者报告的结局测量指标在 ERAS 评估中值得进一步研究。
