Diffusion of Enhanced Recovery principles in gynecologic oncology surgery: Is active implementation still necessary?

J. de Groot*, L.E.J.M. van Es, José M.C. Maessen, C.H.C. Dejong, R.F.P.M. Kruitwagen, B.F.M. Slangen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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OBJECTIVE: Spontaneous diffusion of the evidence-based Enhanced Recovery After Surgery (ERAS) program from an early adopter department (colorectal surgery) to other closely related departments (gynecologic surgery) within the same hospital could be expected. Given this diffusion hypothesis, this quality improvement study examines the value of active implementation of ERAS in addition to spontaneous diffusion. METHODS: A nonrandomized, pre-post intervention study was conducted at a tertiary referral hospital. Prospective data of consecutive patients who underwent abdominal surgery between March, 2010 and March, 2011 for gynecologic malignancies were collected and compared with those of a historical cohort of patients treated before the structured implementation of ERAS by an expert team. Outcomes were length of hospital stay, length of functional recovery, and compliance to protocol care elements. RESULTS: Seventy-seven patients treated after structured implementation of ERAS were compared with 38 patients included in the historical cohort. Most women had surgery for ovarian or endometrial cancer (48% and 37% respectively). Postoperative care mostly lacked ERAS elements and needed to be actively implemented. With structured implementation, a reduced time to functional recovery (median 3 versus 6days, p<0.001) and a shorter length of hospital stay (5 versus 7days, p<0.001) were achieved. CONCLUSIONS: After several years of practicing ERAS in colorectal surgery, spontaneous spread of ERAS principles to gynecologic oncology surgery occurred partially. The results of this study underscore the need for a structured and supported pro-active process to implement the ERAS program in a complete and successful way.
Original languageEnglish
Pages (from-to)570-575
Number of pages6
JournalGynecologic Oncology
Issue number3
Publication statusPublished - Sept 2014


  • Perioperative care
  • Enhanced Recovery After Surgery
  • Implementation
  • Gynecologic oncology
  • Abdominal surgery
  • CARE

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