Implementation of enhanced recovery after surgery in gynaecologic oncology surgery: where should we start?

Compliance with elements of an enhanced recovery after surgery (ERAS) protocol is associated with better outcomes, including decreased length of hospital stay (LHS), but complete implementation is challenging. This study aimed to identify the role of individual ERAS elements on LHS to facilitate the implementation process.

This retrospective single-centre study included 233 women with gynaecological cancers who underwent surgery between 1 February 2021 and 31 July 2023. The first 120 consecutive patients after implementation of the ERAS programme were defined as the ERAS group, and the other patients were in the pre-ERAS group. The groups were compared in terms of LHS. Univariate and multi-variate analyses were used to define independent predictors of decreased LHS (≤5 days).

The median LHS was 6 [interquartile range (IQR) 1-29] days for the ERAS group and 7 (IQR 3-23) days for the pre-ERAS group (p = 0.006). Avoidance of mechanical bowel preparation (p = 0.007), avoidance of surgical site drainage (p < 0.001), removal of urinary drainage before postoperative day 3 (p = 0.02), regular diet initiation on postoperative day 0 (p = 0.02), and reduction in total opioid dose (p = 0.006) were significantly associated with LHS ≤ 5 days on univariate analysis. On multi-variate analysis, avoidance of surgical site drainage (p = 0.014), removal of urinary drainage before postoperative day 3 (p = 0.037), and reduction in total opioid dose (p = 0.045) remained significant for LHS ≤ 5 days.

Avoidance of surgical site drainage, removal of urinary drainage before postoperative day 3, and reduction in total opioid dose were found to be independent predictors of decreased LHS among ERAS items. Special consideration should be given to these items during the adoption of ERAS programmes.