title: Diffusion of Enhanced Recovery principles in gynecologic oncology surgery: is active implementation still necessary?
abstract: OBJECTIVE
  Spontaneous diffusion of the evidence-based Enhanced Recovery After Surgery (ERAS) program from an early adopter department (colorectal surgery) to other closely related departments (gynecologic surgery) within the same hospital could be expected. Given this diffusion hypothesis, this quality improvement study examines the value of active implementation of ERAS in addition to spontaneous diffusion.
  
  
  METHODS
  A nonrandomized, pre-post intervention study was conducted at a tertiary referral hospital. Prospective data of consecutive patients who underwent abdominal surgery between March, 2010 and March, 2011 for gynecologic malignancies were collected and compared with those of a historical cohort of patients treated before the structured implementation of ERAS by an expert team. Outcomes were length of hospital stay, length of functional recovery, and compliance to protocol care elements.
  
  
  RESULTS
  Seventy-seven patients treated after structured implementation of ERAS were compared with 38 patients included in the historical cohort. Most women had surgery for ovarian or endometrial cancer (48% and 37% respectively). Postoperative care mostly lacked ERAS elements and needed to be actively implemented. With structured implementation, a reduced time to functional recovery (median 3 versus 6 days, p<0.001) and a shorter length of hospital stay (5 versus 7 days, p<0.001) were achieved.
  
  
  CONCLUSIONS
  After several years of practicing ERAS in colorectal surgery, spontaneous spread of ERAS principles to gynecologic oncology surgery occurred partially. The results of this study underscore the need for a structured and supported pro-active process to implement the ERAS program in a complete and successful way.
authors.affiliation: Department of Family Medicine, CAPHRI, School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Electronic address: jeanny.degroot@maastrichtuniversity.nl.
authors.forename: Jeanny J A
authors.initials: JJ
authors.lastname: de Groot
authors.affiliation: Department of Obstetrics and Gynecology, Orbis Medical Centre, P.O. Box 5500, 6130 MB Sittard, The Netherlands.
authors.forename: Lilian E J M
authors.initials: LE
authors.lastname: van Es
authors.affiliation: Department of Family Medicine, CAPHRI, School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Quality and Safety, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: José M C
authors.initials: JM
authors.lastname: Maessen
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM - School for Nutrition, Toxicology, and Metabolism, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Cornelis H C
authors.initials: CH
authors.lastname: Dejong
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Roy F P M
authors.initials: RF
authors.lastname: Kruitwagen
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: Brigitte F M
authors.initials: BF
authors.lastname: Slangen
mesh_terms: D004059:Diffusion of Innovation; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000592:standards*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D020127:Recovery of Function
keywords: Abdominal surgery; Enhanced Recovery After Surgery; Gynecologic oncology; Implementation; Perioperative care