Enhanced Recovery After Surgery (ERAS) in Gynecologic Surgery: A Systematic Review

Abstract

Enhanced recovery after surgery (ERAS) protocol aims to accelerate early recovery and improves postoperative patient outcomes. This protocol, which includes components such as reduction and prevention of postoperative complications, early mobilization, multimodal management of nausea and vomiting, positively affects surgical processes when used in patients undergoing gynaecological surgery. The aim of the present study was to use recent and relevant literature for examining the use of ERAS protocols in patients undergoing gynaecological surgery. Therefore, a systematic review was conducted to identify articles examining ERAS protocols used in patients who underwent gynaecological surgery. Electronic searches were performed in PubMed, Science Direct, MEDLINE, and Google Scholar between January 2015 and January 2021. The primary outcome was length of hospital stay. Secondary outcomes included early recovery, postoperative complications, pain management and narcotic drugs use. Twelve studies were included in the systematic review. Most of the included studies were randomize controlled trials. While six of the studies use all components of fast-track surgery protocols, others used postoperative analgesia, postoperative nausea and vomiting, early mobilization, fluid and carbohydrate loading components. When the results of the studies were examined, it was determined that these protocols shortened the length of hospital stay, provided early recovery and early mobilization, reduced nausea and vomiting, and decreased narcotic drugs use by providing appropriate pain management following gynaecological surgery. ERAS protocols need to be used in this patient group in order to achieve better results in the treatment and in the care of patients who have undergone gynaecological surgery.

Keywords

• Enhanced recovery after surgery
• Fast-track surgery
• Gynecological surgery
• Systematic review.
• Gynecology

Jinekolojik Cerrahide Ameliyat Sonrası Erken İyileşme: Sistematik Derleme

Abstract

Ameliyat sonrası iyileşme protokolü (ERAS), erken iyileşmeyi hızlandırmayı ve ameliyat sonrası hasta sonuçlarını iyileştirmeyi amaçlar. Postoperatif komplikasyonların azaltılması ve önlenmesi, erken mobilizasyon, bulantı ve kusmanın multimodal yönetimi gibi bileşenleri içeren bu protokol, jinekolojik cerrahi geçiren hastalarda kullanıldığında cerrahi süreçleri olumlu etkiler. Bu çalışmanın amacı, jinekolojik cerrahi geçiren hastalarda ERAS protokollerinin kullanımını inceleme açısından güncel ve ilgili literatürü kullanmaktı. Bu nedenle, jinekolojik cerrahi geçiren hastalarda kullanılan ERAS protokollerini inceleyen makaleleri belirlemek için sistematik bir inceleme yapıldı. Ocak 2015 ile Ocak 2021 arasında PubMed, Science Direct, MEDLINE ve Google Scholar'da elektronik aramalar gerçekleştirildi. Birincil sonuç hastanede kalış süresiydi. İkincil sonuçlar erken iyileşme, postoperatif komplikasyonlar, ağrı yönetimi ve narkotik ilaçların kullanımını içermekteydi. Sistematik derlemeye 12 çalışma dahil edildi. Dahil edilen çalışmaların çoğu randomize kontrollü çalışmaydı. Çalışmaların altısı hızlandırılmış bakım protokollerinin tüm bileşenlerini kullanırken, diğerleri postoperatif analjezi, postoperatif bulantı ve kusma, erken mobilizasyon, sıvı ve karbonhidrat yükleme bileşenleri kullanmaktaydı. Çalışmaların sonuçları incelendiğinde bu protokollerin jinekolojik cerrahi sonrası hastanede kalış süresini kısalttığı, erken iyileşme ve erken mobilizasyon sağladığı, bulantı ve kusmayı azalttığı ve uygun ağrı yönetimini sağlayarak narkotik kullanımını azalttığı belirlendi. Jinekolojik cerrahi geçiren hastaların tedavi ve bakımlarında daha iyi sonuçlar elde edebilmek için bu hasta grubunda ERAS protokollerinin kullanılması gerekmektedir.

Keywords

• Ameliyat sonrası erken iyileşme
• jinekoloji
• jinekolojik cerrahi
• sistematik derleme

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