Implementation of Enhanced Recovery After Surgery (ERAS) Protocols and Return to Intended Oncologic Therapy: Where We Were and Where We are Going?

Objective: Enhanced recovery after surgery (ERAS) utilizes a multimodal, evidence-based approach to improvepatient postoperative recovery and return to functional baseline. Among gynecologic oncology patients, ERAS protocols are associated with a decrease in complication rate and shorter hospital stays. With the improved return to baseline function recovery times, oncology patients are able to begin adjuvant therapy within the recommended timeframe as to not impact overall survival. We performed a cohort study at the initiation of our gynecologic Oncology ERAD program to determine if this decreased time to planned adjuvant therapy among gynecologic oncology patients after laparotomy. Secondary endpoints included protocol adherence, length of stay, complication rates, and readmission. Methods: We performed a retrospective chart review of 137 pre-ERAS and 73 post-ERAS patients diagnosed at a NCI-designated comprehensive care center in NJ to compare gynecologic oncologic and peri-operative outcomes before and after implementation of ERAS protocols. The protocols were based on recommendations from the ERAS society for management of gynecologic and gynecologic oncologic patients. Twenty-five interventions were analyzed and 12 were included in the final analysis. Pre-ERAS patients were identified by ICD-10 diagnosis code and CPT laparotomy codes. Patient characteristics, length of hospital stay, and complications rates were recorded. Institutional review board approval was obtained from Rutgers University and the Scientific Review Board approval from the Cancer Institute of New Jersey. Results: Twenty-five protocol elements were investigated, with an overall decrease in readmission rate and complication rate between the pre- and postERAS cohorts. There was no difference in length of hospital stay (median, interquartile range of 5 [4-7] and 5 [3-7] in the pre-ERAS and post-ERAS groups, respectively (P=0.91). Similarly, the two groups did not differ based on time to intended oncologic therapy (38 [29-55] versus 37 [29-53]; P=0.94). Conclusions: This study highlights the need for further research on ERAS protocol on return to intended oncologic therapy which is known to improve overall oncologic outcomes