The Concept of Evidence-based Medicine Leads to Better Clinical Outcomes: Guidelines for Enhanced Recovery after Surgery in Gynecologic/ Oncology 2019 Update and Interpretation

Enhanced Recovery After Surgery (ERAS) is now firmly established as a global initiative for the improvement of surgical quality, which results in both clinical improvements and cost benefits to the healthcare system. The ERAS Gynecologic/Oncology guidelines were first published in February 2016. It had been updated in February 2019, representing the joint efforts of the ERAS? Society (www.erassociety.org) and the authors from the international ERAS Gynecology chapters, to present an updated consensus review of perioperative care for gynecologic/oncology surgery based on the best current evidence. There are six new items for 2019 guidelines, including prehabilitation, surgical site infection reduction bundles, patient-reported outcomes, pelvic exenteration and hyperthermic intraperitoneal chemotherapy, discharge pathways, and audit and reporting. Compared with the 2016 guidelines, the currently updated guidelines have ten items with differences in the quality of evidence and recommendation grade and five items with no change. This updated ERAS guidelines aim to further disclose the direction of the perioperative clinical practice of gynecologic/oncology.