Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynaecologic Oncology: A Randomized Clinical Trial.

Objective

ERAS protocols in major gynaecologic oncology surgery (MGOS), have established effectiveness in reducing complications, Length of Stay (LOS), and hospital costs. Their implementation appears to improve patient care compared to conventional perioperative practice. This study assessed the efficacy of ERAS protocol versus conventional postoperative care in the recovery of patients undergoing major gynaecological oncology surgery (MGOS).

Methods

A prospective, randomized, single-centre study. A sample size of convenience included 101 patients with gynaecological cancer who underwent MGOS. Patients randomized into two groups: in group A (n=51, 50.5%), patients allocated to the ERAS protocol, and in group B (n=50, 49.5%), patients followed conventional care.

Results

The mean age in group A was 52.8 years and in group B 56.7 years (p = 0.1). In the ERAS group the LOS was significantly lower compared to the control group, mean 3.9 versus 5.9 days (p < 0.001). All indicators of recovery, such as mobilisation, feeding, bowel motility , discontinuation of intravenous (IV) administration, catheter and drainage removal in the first 24 hours, were significantly improved in patients in the ERAS group. Furthermore complications in patients in the ERAS group, such as fever, urinary tract infection, and perioperative bleeding, were also significantly lower.

Conclusion

Within the limitations of a small single centre RCT, ERAS protocol in MGOS appeared to promote early enteral feeding, discontinuation of IV fluids, early gastrointestinal motility , faster removal of drainage and bladder catheter, faster patient standing and mobilisation, fewer requirements for blood transfusion, lower rate of drowsiness and sedation and episodes postoperative fever and leukocytosis.