Background:The importance of integrating enhanced recovery after surgery protocols in gynecologic oncology has been proven in numerous studies. However, the actual adherence to protocol among institutions remains inconsistent in clinical practice, particularly among those without prior structured implementation. This pragmatic multicenter study provides a preliminary report from the ongoing ERGO (Enhanced Recovery in Gynecologic Oncology) cohort study (ClinicalTrials.gov: NCT06655506) and aims to evaluate adherence to enhanced recovery protocols during the early phases of its adoption as well as identify factors that determine low uptake.Methods:Overall, 300 consecutive patients undergoing gynecologic oncology surgery across five institutions were included in the present study. Adherence to preoperative, intraoperative, and postoperative enhanced recovery elements was documented using standardized forms. Optimal adherence was predetermined as fulfillment of more than 70% of the enhanced recovery components included in the pathway. Multinomial analysis was used to identify predictors of adherence.Results:Overall, 70.3% of patients achieved optimal adherence; however, rates varied across centers (26.9–84.4%), reflecting the limited institutional familiarity with enhanced recovery pathways in most participating centers. The actual volume of cases handled was an important determinant of adherence, with high-volume units consistently demonstrating substantially higher compliance compared with lower-volume hospitals. Routine preoperative items demonstrated high uptake, whereas several intraoperative and early postoperative components showed low and heterogeneous implementation, which might be the result of anesthesiology-driven practices. Higher surgical complexity and poorer performance status independently predicted reduced adherence. Visual mapping confirmed that complex procedures resulted in lower adherence.Conclusions:The significant variability in enhanced recovery protocol adherence that was observed in our study indicates the need to institute structured workflows that help increase team familiarization, particularly in high-complexity cases and centers new to these elements.
背景：多项研究已证实，在妇科肿瘤学中整合加速康复外科方案的重要性。然而，在临床实践中，各机构对方案的实际依从性仍不一致，尤其是在那些先前未进行结构化实施的机构中。这项实用性多中心研究提供了正在进行的ERGO（妇科肿瘤加速康复）队列研究（ClinicalTrials.gov: NCT06655506）的初步报告，旨在评估在方案采纳早期阶段对加速康复方案的依从性，并确定导致采纳率低的因素。 方法：本研究共纳入来自五个机构的300名连续接受妇科肿瘤手术的患者。使用标准化表格记录对术前、术中和术后加速康复要素的依从情况。最佳依从性预先定义为完成路径中包含的70%以上的加速康复组成部分。采用多项分析来确定依从性的预测因素。 结果：总体而言，70.3%的患者达到了最佳依从性；然而，各中心的依从率存在差异（26.9%至84.4%），这反映出大多数参与中心对加速康复路径的机构熟悉度有限。实际处理的病例量是依从性的一个重要决定因素，与低病例量医院相比，高病例量单位始终表现出显著更高的依从性。常规术前项目显示出较高的采纳率，而一些术中和术后早期组成部分的实施率较低且参差不齐，这可能是麻醉学主导实践的结果。更高的手术复杂性和更差的体能状态独立预测了依从性的降低。可视化映射证实，复杂手术导致了更低的依从性。 结论：我们研究中观察到的加速康复方案依从性的显著差异表明，需要建立结构化的工作流程，以帮助提高团队的熟悉度，特别是在高复杂性病例和初次接触这些要素的中心。
肿瘤(癌症)患者之家