Adherence and Compliance to ERAS in Gynecological Surgery as Predictor of Postoperative Complications

The aim of this prospective multicenter observational study is to investigate the association between the early non-compliance to ERAS in postoperative day 2 (POD2) with the rate of postoperative complications, in women undergoing open surgery for gynecological cancer.

Every POD is defined from 8.00 AM of the same day until 8.00 AM of the day after. Namely, POD0 is the day of surgery, while POD1 is the first day after surgery and so on.

According to the ERAS protocol the same day of surgery (POD0) the patients should be mobilized out of bed and allowed to take liquids by mouth at will. Removal of urinary catheter and starting of oral feeding is planned on POD1. Intravenous fluid infusion is stopped as early as possible according to oral feeding recovery at POD1.

POD2 is considered more adequated to measure the early ERAS compliance compared to POD1. In fact, according to previous published data in colonic surgery, a small delay in recovery within an ERAS pathway in POD1, can be the reflection of inadvertent intraoperative fluid overload, inadequate control pain and missing nausea and vomiting prophylasis. Moreover, late end time of surgery can further impair the full application of ERAS during POD1.

The compliance of the participants will be assessed in POD2 using the following 5 indicators derived from ERAS items.