Enhanced Recovery After Surgery (ERAS) for Hysterectomy - A Systematic Review

Purpose: Enhanced Recovery After Surgery (ERAS) is an evidence-based recovery programme that aids in the recovery time following major surgery to improve clinical outcomes while reducing demand on impatient beds. Previous studies from multiple specialities have demonstrated positive effects of ERAS, including colorectal, liver and pancreatic surgery with ERAS pathways becoming part of normal practice. The aim of this study was to systematically review the impact of ERAS in hysterectomy for benign conditions. Methods: A comprehensive literature search was undertaken using CINAHL, EMBASE and PubMed using the search terms ‘Multi-modal’ or ‘fast track’ or ‘ERAS’ or ‘enhanced recovery’ or ‘same day discharge’ and ‘hysterectomy. In accordance with the PRISMA checklist, articles were selected for inclusion based on predetermined criteria, and a narrative synthesis was used to systematically review the selected articles. Results: Eight articles describing the use of ERAS protocols in hysterectomy for benign conditions were identified. Three were cohort studies, three randomised controlled trials (RCTs) and two case-control studies. While there were no significant differences in postoperative pain, patient satisfaction, postoperative complications, or readmissions between groups, length of stay and cost were both decreased in the ERAS groups. Conclusions: The use of ERAS protocols for hysterectomy resulted in reduced length of stay without increasing rates of complications or readmissions.