Gynecologic Oncology 173(2023)58-67Contents lists available at ScienceDirect8888Gynecologic OncologyELSEVIERjournal homepage:www.elsevier.com/locate/ygynoEnhanced recovery after surgery(ERASR)society guidelines forgynecologic oncology:Addressing implementation challenges-2023 updateG.Nelsona*,C.Fotopoulou b,J.Taylor,G.Glaserd,J.Bakkum-Gamezd,LA.Meyer R.Stone e,G.Mena,K.M.Elias A.D.Altman S.P.Bisch P.T.Ramirez i,S.C.Dowdy dDepartment of Obstetrics Gynecology.Cumming School of Medicine.University ofCalgary.Calgary.Alberta,CanadaDepartment of Gynecologic Oncology and Reproductive Medicne,The University of Texas MD Anderson Cancer Center,Houston,TX USADivision of Gynecologic Oncology,Mayo Clinic College of Medicne,Rochester,MN,USADepart ment of Gynecology and Obstetrics Johns Hopkins School of Medicine,Baltimare,MD.USADeparment of Anesthesiology.CriticalCre and Pain Medicine.The University of Texs MD Anderson Cancer Center.Houston,X.USADivision of Gynecologic Oncology,Department of Obstetrics and Gynecology and Reproductive Biology,Brigham and Women's Hospital Dana-Farber Cancer Institute,Harvard Medical School,Boston,MA,USADepartment of Obstetrics Gynecology and Reproductive Scences,University of Manitoba,Winnipeg Manitoba CanadaDepartment of Obstetricsand Gynecology.Houston Methodist Hospital,Houston,TX USAHIGHLIGHTSDespite best efforts,many of the ERAS recommendations remain poorly adhered to and barr iers to ERAS implementation persistThis guideline update summarizes evidence investigating ERAS implementation challenges highlighted by stakeholder groups.Overcoming implementation barriers will increase ERAS uptake and improve clinical outcomes for patients.ARTICLE INFOABSTRACTArtide history:Background.Despite evidence supporting its use,many Enhanced Recovery After Surgery (ERAS)recommen-Received 27 February 2023dations remain poorly adhered to and barriers to ERAS implementation persist.In this second updated ERASReceived in revised form 11 April 2023Society guideline,a consensus for optimal perioperative care in gynecologic oncology surgery is presented.Accepted 13 April 2023with a specific emphasis on implementation challenges.Available online xxxMethods.Based on the gaps identified by clinician stakeholder groups,nine implementation challenge topicsKeywords:were prioritized for review.A database search of publications using Embase and PubMed was performedEnhanced recovery after surgery(2018-2023).Studies on each topic were selected with emphasis on meta-analyses,randomized controlled trials.ERASand large prospective cohort studies.These studies were then reviewed and graded by an international panelPerioperative careaccor ding to the Gr ading of Recommendations,Assessment,Development and Evaluation (GRADE)system.Surgical qualityResulrs.All recommendations on ERAS implementation challenge topics are based on best available evidence.Gynecologic oncology surgeryThe level ofevidence for each item is presented accordingly.Conclusions.The updatedevi
