The ERAS® Society Handbook for Obstetrics & Gynecology

1st Edition - June 8, 2022
Editors: Gregg Nelson, Pedro T. Ramirez, Sean C. Dowdy, R. Douglas Wilson, Michael J. Scott
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 2 0 8 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 1 8 2 5 - 1

The ERAS® Society Handbook for Obstetrics & Gynecology covers all aspects of enhanced recovery care for disciplines of general gynecology, gynecologic oncology, urogyneco… Read more

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The ERAS® Society Handbook for Obstetrics & Gynecology covers all aspects of enhanced recovery care for disciplines of general gynecology, gynecologic oncology, urogynecology and obstetrical surgery. Written by renowned experts in the field, chapters discuss foundational knowledge on ERAS and provide specific worked examples, ERAS order sets, and practical implementation tools. This book is an indispensable resource to researchers interested in ERAS, but it is also ideal for anesthesiologists, gynecologists and obstetricians interested in initiating an ERAS program.

Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative that originated in colorectal surgery and has now spread to numerous other disciplines, including gynecology (benign and malignant) and obstetrics (caesarean delivery). ERAS is associated with improvements in clinical outcomes (reduction in length of hospital stay, complications, readmissions), cost savings for the healthcare system, and patient satisfaction, hence the addition of this comprehensive resource on the topics is a welcomed addition to the available literature.

Cover
Title page
Table of Contents
Copyright
Contributors
About the editors
Foreword
Preface
Section I: Preoperative
Chapter 1: Prehabilitation
Abstract
What is prehabilitation and why do we need it?
Current status of prehabilitation programs
Elements of prehabilitation
Conclusions
Summary points
References
Chapter 2: Preoperative optimization
Abstract
Introduction
Preoperative optimization as part of enhanced recovery pathway
Patient risk assessment
Age and frailty
Anemia
COVID-19 status
Psychological factors: Chronic pain and opioid tolerance
Pulmonary and OSA
Hypertension
Cardiovascular: Atrial fibrillation, coronary artery disease
Diabetes
Renal disease
Anticoagulation: DOACs, warfarin, and antiplatelet therapy
Antibiotics and allergy testing
Decolonization
Day of surgery routine medications
Hydration and carbohydrate loading
Conditions specific to GYN oncology
Timeline for preoperative optimization
Implementing a preoperative clinic into a health system
Summary points
References
Chapter 3: Bowel preparation
Abstract
Introduction
Definitions
Discussion
Summary points
References
Chapter 4: Preoperative fasting and carbohydrate loading
Abstract
Preoperative fasting
Preoperative carbohydrate loading
Immunonutrition
Summary points
References
Section II: Intraoperative
Chapter 5: Anesthetic protocol
Abstract
Introduction
Obstetrics
Central neuraxial block in obstetrics
General anesthesia in obstetrics
Gynecology
Anesthetic protocol for major gynecology procedures
Conclusions
Summary points
References
Chapter 6: Surgical site infection prevention
Abstract
Introduction
Terminology
Antimicrobial prophylaxis
Smoking cessation
Skin and vaginal preparation
Avoidance of hyperglycemia
Wound interventions
Nutritional status
Conclusion
Summary points
References
Chapter 7: Avoidance of drains and tubes
Abstract
Background
Nasogastric tube
Peritoneal drains
Urinary catheter
Cesarean section
Subcutaneous drain/groin drain
Pleural cavity drains
Conclusion
Summary points
References
Chapter 8: Maintenance of normothermia
Abstract
Introduction
Physiology of thermoregulation
Thermoregulation under different types of anesthesia
The impact of hyperthermia
The impact of hypothermia
How to maintain normothermia
Monitoring of body temperature
Conclusions
Summary points
References
Chapter 9: Fluid and hemodynamic therapy
Abstract
Introduction
Fluids and enhanced recovery after surgery programs
Surgical stress response
Types of intravenous fluids
Cardiac output monitoring
Goal-directed fluid therapy
Obstetrics
Gynecology
Conclusion
Summary points
References
Chapter 10: Postoperative nausea and vomiting: A pragmatic program
Abstract
Introduction
Prevention and risk stratification
Standardized multimodal approach
Pathways, pharmacology, and side effects
Treatment
Special considerations
Summary
Summary points
References
Section III: Postoperative
Chapter 11: Postoperative opioid sparing analgesia
Abstract
Introduction
Opioid use considerations
Preoperative opioid use
Postoperative local/regional analgesia
Opioid-sparing multimodal approach
Reducing discharge opioid prescriptions
Pharmacogenomics
Pain control after cesarean section
Considerations in minimally invasive surgery
Summary
Summary points
References
Chapter 12: Impact of early oral intake
Abstract
Introduction
Early oral intake paradigm as part of the ERAS multimodal process of care
The impact of early oral intake
Evidence in specific subspecialties
Nutritional supplementation
Future developments
Conclusion
Summary points
References
Chapter 13: Venous thromboembolic prophylaxis
Abstract
Preoperative anticoagulation
Intraoperative prophylaxis
Immediate postoperative prophylaxis
Extended postoperative prophylaxis
Special populations
Summary points
References
Chapter 14: Early mobilization and impact on recovery
Abstract
Introduction
Early mobilization
Early mobilization in different ERAS pathways
Early mobilization in gynecological surgery
Barriers and facilitators to mobilization
Role of physiotherapists
Conclusion
Summary points
References
Chapter 15: Patient reported outcomes (PROs): Considerations for implementation in your ERAS program
Abstract
Introduction
Using PROs in clinical practice: Background and applicability to ERAS
Planning PRO implementation: Basics for consideration
Planning PRO implementation: Considering resource limitations and respondent burden
Planning PRO implementation: Data interpretation and analysis
PROs in the surgical literature
Summary points
References
Section IV: ERAS implementation
Chapter 16: Creating an ERAS team and order set
Abstract
Introduction
Creating the ERAS team
Creation of the order set
Summary points
References
Chapter 17: Audit of compliance and clinical outcomes
Abstract
Introduction
Designing a robust audit for compliance
Assessing clinical outcomes
Applications of compliance data to clinical research
Reporting compliance for ERAS
Conclusion
Summary points
References
Section V: Discipline specific considerations and outcomes
Chapter 18: Cesarean delivery
Abstract
Introduction
Overview of ERAS and ERAC guidelines
Care pathway elements
Overview of published studies
Summary
Summary points
Conflict of interest to declare
References
Chapter 19: Minimally invasive surgery
Abstract
Introduction
Preoperative considerations
Intraoperative considerations
Postoperative considerations
Minimally invasive bowel surgery for benign disease and ERAS
ERAS outcomes in MIGS
Summary points
References
Chapter 20: Gynecologic oncology
Abstract
Introduction
A brief history of ERAS research in gynecologic oncology
Patient considerations in gynecologic oncology
Surgical considerations of gynecologic oncology
Controversies and areas of uncertainty
Summary points
References
Chapter 21: Urogynecology and pelvic reconstructive surgery
Abstract
Introduction
ERAS protocols in urogynecology
Same-day discharge
Geriatric factors: Frailty, functional, and cognitive status
Perioperative pain management
Persistent chronic pain
Voiding dysfunction
Vaginal packing
Conclusion
Summary points
References
Index

Gregg Nelson

Dr. Gregg Nelson is Professor and Chief of Gynecologic Oncology at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. He is also Deputy Head of the Department of Obstetrics & Gynecology at the Cumming School of Medicine and Surgical Lead, ERAS Alberta. His principal research interest is the development and study of Enhanced Recovery After Surgery (ERAS) protocols in cancer and ObGyn surgery. Dr. Nelson and his international team of collaborators published the ERAS® Guidelines for Gynecologic/Oncology Surgery (2016 and updated in 2019), publications that have transformed and helped to align perioperative care in the discipline. Dr. Nelson’s expertise in this area is recognized internationally through his leadership roles as Secretary of the ERAS® Society and also as the Chair of the ERAS® Society Women’s Health Chapter. Dr. Nelson is also on the organizing committee for the yearly ERAS® Society World Congress.

Affiliations and expertise

Professor and Chief, Division of Gynecologic Oncology, Tom Baker Cancer Centre, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Pedro T. Ramirez

Pedro T. Ramirez MD is Professor of Gynecologic Oncology at MD Anderson Cancer Center in Houston, Texas. He has authored and co-authored 264 scientific publications and has written 19 book chapters, monographs, and invited articles. He is also the Editor-in-Chief of the International Journal of Gynecological Cancer. In addition, he is the Director of the Enhanced Recovery After Surgery (ERAS) Gynecologic Oncology Program at MD Anderson Cancer Center. Dr. Ramirez is the Principal Investigator of numerous prospective trials, including the LACC Trial. His areas of research interest include outcomes of minimally invasive surgery in gynecologic cancers and enhanced recovery after surgery implementation pathways.

Affiliations and expertise

Chair, Dept of Obstetrics & Gynecology, EIC, Journal of Gynecological Cancer, Houston Methodist Hospital, Houston, TX

Sean C. Dowdy

Sean C. Dowdy is Professor and Chair of Gynecologic Oncology, Midwest Chair of Quality and Affordability, and Deputy Chief Value Officer for Mayo Clinic in Rochester, MN. He has authored over 200 peer reviewed publications, and led national initiatives to accelerate postoperative recovery, reduce length of hospital stay, improve pain control and reduce complications for women undergoing surgery for gynecologic cancers. His clinical focus is on minimally invasive surgery and complex surgery for patients with advanced gynecologic cancer.

Affiliations and expertise

Professor, Mayo Clinic, Rochester, MN, United States

R. Douglas Wilson

R. Douglas Wilson is Professor Emeritus and previous Head of the Department of Obstetrics and Gynecology in The University of Calgary, Canada. His research interest includes congenital anomalies, prenatal diagnosis (screening, non-invasive imaging ultrasound, MRI, low radiation CT), invasive prenatal diagnosis (chorionic villus sampling, amniocentesis, cordocentesis, fetoscopy), fetal therapy and maternal serum DNA/RNA fetal analysis.

Affiliations and expertise

Professor Emeritus, University of Calgary, Calgary, AB, Canada

Michael J. Scott

Michael James Scott is a Professor and Chief of Critical Care Medicine in Penn Medicine, USA. He has over 25-year experience in Anesthesiology and Critical Care Medicine, and his research interest includes pathophysiology of surgery and perioperative outcomes, analgesia, functional outcomes and opioid sparing. Dr. Scott’s work in basic sciences and quality improvement has led to worldwide acceptance of a new approach to care of the surgical patient – Enhanced Recovery After Surgery (ERAS). In 2003 his department’s published work has helped build the evidence base that rapid recovery after surgery leads to improved outcomes, reduced complications and reduced costs.

Affiliations and expertise

Professor, University of Pennsylvania, Philadelphia, PA, United States