1. Implementation of an ERAS Program for Gynecological Oncology Surgery
Jordan Lewis & Dr. Kelly Mayson, Summer 2016

2. Enhanced Recovery After Surgery (ERAS)
Surgical “fast-track” program
Multimodal, evidence-based perioperative care pathway
Success in Europe for 10+ years
Validated to achieve early recovery after major surgeries
Auditing compliance is key
Aimed to achieve enhanced, better, and faster recovery
through up to 21 pre-, intra-, and post-op components which each contribute to less complications and faster recovery
Nothing new – started in the 1990s, used in a large European collaborative since early 2000, and many hospitals have began adopting ERAS for a variety of specialties
ERAS protocol: has been implemented for specialties (i.e. general surgery, urology), but has yet to be implemented for gynecology oncology – this is the next phase
Key Points: Active Patient Involvement 2) Involvement of the whole care team throughout the pt journey 3) Auditing the compliance & patient outcomes

3. Summer Objectives: My Role
Pre- and Post- ERAS Implementation:
Audit compliance for endometrial, ovarian & cervical cancer procedures
Extract data from patient charts: real- time & retrospective
Follow 30-day outcomes
Assess patient satisfaction through follow-up phone call and questionnaire
Recently, ERAS society has come out with official guidelines of gyne/onc
to assess successful ERAS implementation and sustainability
Patient-centered program*
Data feeds back into improving
Objective: successfully implement ERAS in gyn/onc (80% compliance)

4. IMPLEMENTATION Late Aug-early Sept
Timeline
IMPLEMENTATION Late Aug-early Sept
>80%
FUTURE DIRECTIONS:
>80% compliance in all ERAS components (live feedback)
30-day outcomes on 100% ERAS cases
Audit and compare pre- and post-ERAS outcomes
UP UNTIL NOW:
Ongoing education for all staff
Develop ERAS documents
Acquire NSQIP data
CURRENTLY:
Implement/audit intra-op by core group of anesthesiologists & surgeons
(pre- and post: gradual upon approval)
Acquire data & patient satisfaction from pre-ERAS cohorts
Audit live ERAS charts
Transition period
Currently – gradual upon approval and distribution of ERAS documents & staff education

5. Anticipated Results
Reduction in symptoms delaying discharge, 30 day morbidity, and readmissions
↓ hypotension in PACU
↓ excessive pain
↓ PONV
↓ LOS
N= 953 , * p < 0.05
Retrospective review of 953 cases from under going procedures for colorectal cancer.
Include but not limited to…
to ERAS protocol
Gustafsson et al. Arch Surg 2011: 146(5)

6. Thank you!