Perioperative Care in Gynecologic Oncology Surgery Clinical Practice Guidelines (2019)

Enhanced Recovery After Surgery (ERAS) Society

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 29, 2019

The guidelines on perioperative care in gynecologic oncology surgery were released on March 15, 2019, by the Enhanced Recovery After Surgery (ERAS) Society.[1]

Patients should receive preoperative counseling to inform them on surgical and anesthetic procedures and postoperative care plan.

Preoperative bowel preparation should not be used before minimally invasive gynecologic surgery and open laparotomy.

Patients should eat a light meal up to 6 hours before the initiation of anesthesia and also drink clear fluids, including oral carbohydrate drinks, up to 2 hours before the initiation of anesthesia.

Dual mechanical prophylaxis and chemoprophylaxis should be used for all patients at risk for venous thromboembolism. Extended chemoprophylaxis should be used in patients who are high risk according to ACCP criteria including patients with advanced ovarian cancer.

The first choice for antibiotic prophylaxis for hysterectomy are first generation cephalosporins. Weight-based dosing should be used.

Chlorhexidine-based antimicrobial soap should be used by patients before surgery and chlorohexidine-alcohol should be used during skin preparation in the OR.

All Enhanced Recovery After Surgery (ERAS) programs should include normothermia maintenance.

Do not use peritoneal drains, subcutaneous drains, and nasogastric tubes after abdominal surgery.

Screen all patients undergoing surgery for diabetes. Glucose levels under 200 mg/dL should be maintained perioperatively for all patients.

Use short-acting anesthetics and monitoring of the level of neuromuscular block and complete neuromuscular block reversal is recommended.

Minimally invasive surgery, including vaginal surgery, should be used when appropriate.

In high-risk patients undergoing abdominal surgery, perioperative goal-directed fluid therapy can reduce complications and length of stay.

A reduction in opioid administration can be achieved through a multimodal postoperative analgesic protocol. This includes decreasing the need for systemic medications by using non-opioid medications and incisional injection of local anesthetic.

A regular diet is recommended within the first 24 hours after gynecologic oncologic surgery.

The length of time it takes for bowl function to return can be decreased by coffee, euvolemia, opioid-sparing analgesia, and early feeding.

For more Clinical Practice Guidelines, please go to Guidelines.

For more information, go to Perioperative Management of the Female Patient.

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