INTRODUCTION: Inspired by Enhanced Recovery After Surgery (ERAS) guidelines by the ERAS Society, we sought to revise our perioperative protocols and patient education to increase favorable health and surgical outcomes by providing evidence-based recommendations and removing unsupported guidelines. METHODS: Current preoperative/postoperative protocols for benign gynecologic surgery were put through an evidence-based literature review using Elsevier, Cochrane Reviews, PubMed, and web-search engines. Preference was given to evidence published after 2015 and assigned a research grading by the Oxford Research scale (2009). Guidance with insufficient evidence was considered by three surgeons to keep or remove based on expert opinion. RESULTS: Twenty-eight of 41 (68.3%) of existing guidelines were supported by A/B Oxford scale level evidence (A=21.4%, B=78.6%). The remaining 13 guidelines showed that 2/13 had sufficient evidence (A/B level) to be removed, while the other 11/13 had insufficient evidence to reject, defined as grades at or below C level. Of these, physicians voted to keep 5/11 guidelines, remove 2/11, and modify 4/11. In total, 4 guidelines were removed based on sufficient evidence to reject or a total lack of evidence, and the remaining guidelines were modified to account for patient safety risk or perceived patient satisfaction. CONCLUSIONS/IMPLICATIONS: A/B graded research now supports 75.7% of the revised guidelines, representing a 7.4% increase. The remaining guidelines were agreed upon as necessary contributions or modified based on expert opinion. Overall, the new guidelines represent a higher percentage of evidence-based practices and less restrictive preoperative/postoperative recovery protocols to align with current data regarding enhanced recovery protocols.
Burton et al. (2026) studied this question.