The ERAS® Society Handbook for Obstetrics & Gynecology

Dr. Gregg Nelson is Professor and Chief of Gynecologic Oncology at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. He is also Deputy Head of the Department of Obstetrics & Gynecology at the Cumming School of Medicine and Surgical Lead, ERAS Alberta. His principal research interest is the development and study of Enhanced Recovery After Surgery (ERAS) protocols in cancer and ObGyn surgery. Dr. Nelson and his international team of collaborators published the ERAS® Guidelines for Gynecologic/Oncology Surgery (2016 and updated in 2019), publications that have transformed and helped to align perioperative care in the discipline. Dr. Nelson’s expertise in this area is recognized internationally through his leadership roles as Secretary of the ERAS® Society and also as the Chair of the ERAS® Society Women’s Health Chapter. Dr. Nelson is also on the organizing committee for the yearly ERAS® Society World Congress. Pedro T. Ramirez MD is Professor of Gynecologic Oncology at MD Anderson Cancer Center in Houston, Texas. He has authored and co-authored 264 scientific publications and has written 19 book chapters, monographs, and invited articles. He is also the Editor-in-Chief of the International Journal of Gynecological Cancer. In addition, he is the Director of the Enhanced Recovery After Surgery (ERAS) Gynecologic Oncology Program at MD Anderson Cancer Center. Dr. Ramirez is the Principal Investigator of numerous prospective trials, including the LACC Trial. His areas of research interest include outcomes of minimally invasive surgery in gynecologic cancers and enhanced recovery after surgery implementation pathways. Sean C. Dowdy is Professor and Chair of Gynecologic Oncology, Midwest Chair of Quality and Affordability, and Deputy Chief Value Officer for Mayo Clinic in Rochester, MN. He has authored over 200 peer reviewed publications, and led national initiatives to accelerate postoperative recovery, reduce length of hospital stay, improve pain control and reduce complications for women undergoing surgery for gynecologic cancers. His clinical focus is on minimally invasive surgery and complex surgery for patients with advanced gynecologic cancer. R. Douglas Wilson is Professor Emeritus and previous Head of the Department of Obstetrics and Gynecology in The University of Calgary, Canada. His research interest includes congenital anomalies, prenatal diagnosis (screening, non-invasive imaging ultrasound, MRI, low radiation CT), invasive prenatal diagnosis (chorionic villus sampling, amniocentesis, cordocentesis, fetoscopy), fetal therapy and maternal serum DNA/RNA fetal analysis. Michael James Scott is a Professor and Chief of Critical Care Medicine in Penn Medicine, USA. He has over 25-year experience in Anesthesiology and Critical Care Medicine, and his research interest includes pathophysiology of surgery and perioperative outcomes, analgesia, functional outcomes and opioid sparing. Dr. Scott’s work in basic sciences and quality improvement has led to worldwide acceptance of a new approach to care of the surgical patient – Enhanced Recovery After Surgery (ERAS). In 2003 his department’s published work has helped build the evidence base that rapid recovery after surgery leads to improved outcomes, reduced complications and reduced costs.

SECTION I. PREOPERATIVE 1. Prehabilitation 2. Preoperative optimization 3. Updates on bowel preparation 4. Preoperative fasting and carbohydrate loading

SECTION II. INTRAOPERATIVE 5. Anesthetic protocol 6. Surgical site infection prevention 7. Avoidance of drains and tubes 8. Maintenance of normothermia 9. Fluid and hemodynamic therapy 10. Postoperative nausea and vomiting: A pragmatic program

SECTION III. POSTOPERATIVE 11. Postoperative opioid sparing analgesia 12. Impact of early oral intake 13. Venous thromboembolic prophylaxis 14. Early mobilization and impact on recovery 15. Patient reported outcomes (PROs)

SECTION IV. ERAS IMPLEMENTATION 16. Creating an ERAS team and order set 17. Audit, compliance, and research design

SECTION V. DISCIPLINE SPECIFIC CONSIDERATIONS AND OUTCOMES 18. Discipline specific considerations and outcomes: Obstetrical surgery 19. Discipline specific considerations and outcomes: Minimally invasive surgery 20. ERAS Gynecologic oncology 21. Urogynecology