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Implementation Rates and Predictors of Compliance with Enhanced Recovery After Surgery Protocols in Gynecologic
Vasilios Pergialiotis1, Dimitrios Haidopoulos1, Alexandros Daponte2
1First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Cancers
|December 30, 2025
Summary
Adherence to enhanced recovery protocols in gynecologic oncology surgery varies significantly by institution. High-volume centers and simpler procedures show better compliance, highlighting the need for structured implementation and team familiarization.
Area of Science:
- Gynecologic Oncology
- Surgical Protocols
- Healthcare Implementation Science
Background:
- Enhanced recovery after surgery (ERAS) protocols are crucial in gynecologic oncology but show inconsistent adherence.
- Many institutions lack structured implementation, leading to variable uptake of ERAS pathways.
- The ERGO cohort study investigates early adoption and adherence factors for ERAS in gynecologic oncology.
Purpose of the Study:
- To evaluate adherence to enhanced recovery protocols during early adoption phases.
- To identify factors influencing the uptake of ERAS pathways in gynecologic oncology.
- To report preliminary findings from the ERGO cohort study.
Main Methods:
- A pragmatic, multicenter study included 300 consecutive gynecologic oncology surgery patients.
- Adherence to preoperative, intraoperative, and postoperative ERAS elements was systematically documented.
- Multinomial analysis identified predictors of adherence, with optimal adherence defined as >70% component fulfillment.
Main Results:
- Overall optimal adherence was 70.3%, with significant center-specific variability (26.9-84.4%).
- High-volume centers demonstrated superior adherence compared to low-volume hospitals.
- Complex procedures and poorer patient performance status predicted reduced adherence; preoperative elements had high uptake, while intraoperative/postoperative elements were heterogeneous.
Conclusions:
- Significant variability in ERAS protocol adherence necessitates structured workflows for team familiarization.
- Implementation support is particularly crucial for high-complexity cases and centers new to ERAS.
- Addressing factors like case volume and procedure complexity can improve ERAS pathway integration.
