Enhanced Recovery in Gynecologic Surgery

Enhanced Recovery After Surgery (ERAS) is a perioperative quality-improvement program that uses evidence-based interventions within the preoperative, intraoperative, and postoperative phases of surgical care. ERAS interventions aim to decrease the stress response to surgery, and when implemented together in a structured fashion, result in reductions in hospital length of stay, complications, and cost of care as well as improving patients' satisfaction. ERAS is now firmly entrenched in multiple surgical specialties, including gynecology, where recent randomized studies have shown benefit. This review describes ERAS elements relevant to gynecologic surgery (for both benign and malignant indications), including avoiding preoperative fasting and mechanical bowel preparation; giving preemptive analgesia; using a standardized anesthesia protocol; maintaining normothermia and euvolemia; preventing postoperative nausea and vomiting; avoiding use of drains/tubes; and implementing opioid-sparing pain control, early postoperative feeding, early removal of urinary catheter, and active mobilization. A separate section on minimally invasive surgery (vaginal, laparoscopic, and robotic procedures) is included to discuss ERAS considerations specific to these approaches. This is especially important, as the discipline of gynecologic surgery increasingly leans toward same-day discharge.