Enhanced recovery protocols after pelvic floor reconstructive surgery

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) protocols consist of several evidence-based interventions that have been adopted to ameliorate perioperative care. Until this day, no such specific protocols suggested for urogynecology patients, exist. However, there are recent efforts towards the development of such protocols, as it has been shown to have beneficial effects among patients undergoing other gynecological procedures. This review aims to collect and analyze data in the published literature regarding implementation of an enhanced recovery after surgery pathway in a urogynecology population. Material and Methods: An extensive search of the PubMed/Medline and the Cochrane Database was conducted using the following terms: Enhance Recovery After Surgery combined with pelvic floor reconstructive surgery and urogynecology. Related articles from the latest two decades up to May 2021 were scanned for relevance. Results: The interventions concerning the implementation of an enhanced recovery pathway after urogynecologic procedures include preoperative, intraoperative, and postoperative recommendations. The main key items in these protocols comprise of patient education, optimization of comorbid conditions, diet, bowel preparation, antibiotic prophylaxis, fluid intake, anesthesiologic agents, early ambulation, postoperative analgesia, thromboprophylaxis and guidance after discharge. Conclusions: Implementation of an ERAS protocol in urogynecology-specific population has been proven to have a beneficial effect on decreasing hospital stay without increasing the rate of post-operative complications. Nonetheless, the scarcity of evidence-based studies in the literature, regarding the implementation of an ERAS protocol in gynecologic pelvic floor reconstructive surgery is apparent. Hence, further research is required with studies targeted towards urogynecology for safer conclusions to be made.