The ERAS® Society Handbook for Obstetrics & Gynecology

The ERAS® Society Handbook for Obstetrics & Gynecology

1st Edition - June 8, 2022

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  • Editors: Gregg Nelson, Pedro T. Ramirez, Sean C. Dowdy, R. Douglas Wilson, Michael J. Scott
  • Paperback ISBN: 9780323912082
  • eBook ISBN: 9780323918251

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Description

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.

Key Features

  • Covers all aspects of enhanced recovery care for the disciplines of general gynecology, gynecologic oncology and obstetrical surgery
  • Enables gynecologists and obstetricians to realize improvements in clinical outcomes for their patients by providing knowledge and practical tools for implementation of the ERAS program
  • Discusses specific worked examples and provides practical implementation tools

Readership

General gynecologists, obstetricians, gynecologic oncologists, urogynecologists, anesthesiologists with interest in OBGYN surgery

Table of Contents

  • 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

Product details

  • No. of pages: 368
  • Language: English
  • Copyright: © Academic Press 2022
  • Published: June 8, 2022
  • Imprint: Academic Press
  • Paperback ISBN: 9780323912082
  • eBook ISBN: 9780323918251

About the Editors

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

Professor, Department of Gynecologic Oncology & Reproductive Medicine, MD Anderson Cancer Center, Houston, TX, United States

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

Ratings and Reviews

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  • Arthur H. Tue Aug 09 2022

    ERAS society handbook for obgyn

    Great read. the interface was good. content was excellent. Highly recommend!