The intent of this quality improvement project was to develop and implement an enhanced recovery after surgery (ERAS) protocol for the gynecological oncology surgical population based on current evidence. Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary protocol that guides recommendations for the pre-operative, intra-operative and postoperative phases of surgical care. ERAS protocols have been developed and applied to various surgical populations showing favorable outcomes including shorter length of hospital stay (LOS), a reduction in postoperative nausea and vomiting (PONV), and a decrease in opioid consumption. Gynecological oncology surgical procedures are associated with postoperative complications including an increased risk for PONV and inadequate pain management. These complications are associated with increased time spent in the post anesthesia care unit (PACU) and overall length of hospital stay which leads to an increase in hospital costs. Recommendations to prevent PONV and reduce opioid consumption are present in the literature for gynecological oncology patients in all phases of surgical care. A literature synthesis was conducted to develop an ERAS protocol for preoperative, intra operative, and postoperative phases of surgical care. The protocol was developed and implemented at a hospital in West Michigan. Retrospective chart audits were performed on the target patient population prior to implementation of ERAS protocol to identify average LOS, PONV, and opioid consumption. Post implementation chart audits were performed on qualifying patients to identify and compare these data points. The data was then analyzed using descriptive statistics. The data showed that there was a reduction in LOS, PONV, and opioid consumption after implementation of the ERAS protocol. These findings were consistent with studies found in the literature synthesis. Compliance to the protocol varied throughout the implementation phase. Utilization of an ERAS protocol on the gynecologic oncology surgical population may lead to decreased LOS, PONV, and opioid consumption. Decreased LOS and reduced postoperative complications may lead to decreased hospital costs. Barriers to compliance should be explored and addressed to improve outcomes.
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