Objectives: Enhanced recovery after surgery (ERAS) protocols provide well-known benefits in the immediate recovery with a shorter length of stay (LOS) and also in gynecological surgery. However, the impact of ERAS has not been clearly showed yet regarding long-term consequences and health-related quality of life (HRQL). The aim of this study was to investigate the impact of ERAS on HRQL after hysterectomy for endometrial cancer. Design: An observational retrospective study with propensity score matching (PSM) was performed. Participants: We administered the SF-36 validated questionnaire to women underwent hysterectomy and lymph nodal staging before and after introducing ERAS protocol, getting, respectively, a standard practice (SP) and ERAS group. Settings: The study was conducted at the academic hospital. Methods: We collected demographic, clinical, surgical and postoperative data and performed a PSM of the baseline confounders. We administered the questionnaire 4 weeks after the surgery. The SF-36 measures HRQL using eight scales: physical functioning (PF), role physical (RLP), bodily pain (BP), general health (GH), vitality (Vt), social functioning (SF), role emotional (RLE) and mental health (MH). Results: After PSM, we enrolled a total of 154 patients, 77 in each group (SP and ERA). The two groups were similar in terms of age, BMI, anesthetic risk, Charlson comorbidity index (CCI), and surgical technique (minimally invasive vs. open access). Median LOS was shorter for ERAS group (5 vs. 3 days; p = 0.02), while no significant differences were registered in the rates of postoperative complications (16.9% vs. 17.4%; p = 0.66). Response rates to SF-36 questionnaire were 89% and 92%, respectively, in SP and ERAS group. At multivariate analyzes, the mean scores of SF-36 questionnaire, registered at 28 days weeks after surgery (range 26–32 days), were significantly higher in ERAS group for PF (73.3 vs. 91.6; p < 0.00), RLP (median 58.3 vs. 81.2; p = 0.02), and SF (37.5 vs. 58.3; p = 0.01) domains, when compared to SP patients. Limitations: Further follow-up was not possible due to the anonymized data derived from clinical audit. Conclusions: ERAS significantly increases the HRQL of women who underwent surgery for endometrial cancer. HRQL assessment should be routinely implemented in the ERAS protocol.

1.
Nelson
G
.
Current oncology reports: enhanced recovery in gynecologic oncology surgery–state of the science
.
Curr Oncol Rep
.
2023
;
25
(
10
):
1097
104
.
2.
Ackert
KE
,
Bauerle
W
,
Pellegrino
AN
,
Stoltzfus
J
,
Pateman
S
,
Graves
D
, et al
.
Implementation of an enhanced recovery after surgery (ERAS) protocol for total abdominal hysterectomies in the division of gynecologic oncology: a network-wide quality improvement initiative
.
J Osteopath Med
.
2023
;
123
(
10
):
493
8
.
3.
Nelson
G
,
Bakkum-Gamez
J
,
Kalogera
E
,
Glaser
G
,
Altman
A
,
Meyer
LA
, et al
.
Guidelines for perioperative care in gynecologic/oncology: enhanced Recovery after Surgery (ERAS) Society recommendations–2019 update
.
Int J Gynecol Cancer
.
2019
;
29
(
4
):
651
68
.
4.
Falcone
F
,
Laganà
AS
,
Casarin
J
,
Chiofalo
B
,
Barra
F
,
Garzon
S
, et al
.
Evaluation of peri-operative management in women with deep endometriosis who are candidates for bowel surgery: a survey from the Italian society of gynecologic endoscopy
.
J Minim Invasive Gynecol
.
2023
;
30
(
6
):
462
72
.
5.
Brooks
NA
,
Kokorovic
A
,
McGrath
JS
,
Kassouf
W
,
Collins
JW
,
Black
PC
, et al
.
Critical analysis of quality of life and cost-effectiveness of enhanced recovery after surgery (ERAS) for patient’s undergoing urologic oncology surgery: a systematic review
.
World J Urol
.
2022
;
40
(
6
):
1325
42
. .
6.
Forte
S
,
Ferrari
FA
,
Majd
HS
,
Cisotto
F
,
Ferrari
F
.
Enhanced recovery after surgery (ERAS) in gynecology: state of the art and the problem of barriers
.
Clin Exp Obstet Gynecol
.
2023
;
50
(
1
):
14
.
7.
Laganà
AS
,
Garzon
S
,
Casarin
J
,
Franchi
M
,
Ghezzi
F
.
Acupoint massage to manage postoperative ileus in gynecologic laparoscopy: a new potential player in the enhanced recovery after surgery (ERAS) pathways
.
J Invest Surg
.
2021
;
34
(
1
):
96
8
.
8.
Miralpeix
E
,
Nick
AM
,
Meyer
LA
,
Cata
J
,
Lasala
J
,
Mena
GE
, et al
.
A call for new standard of care in perioperative gynecologic oncology practice: impact of enhanced recovery after surgery (ERAS) programs
.
Gynecol Oncol
.
2016
;
141
(
2
):
371
8
.
9.
Gustafsson
UO
,
Oppelstrup
H
,
Thorell
A
,
Nygren
J
,
Ljungqvist
O
.
Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery: a retrospective cohort study
.
World J Surg
.
2016
;
40
(
7
):
1741
7
.
10.
Ferrari
F
,
Forte
S
,
Sbalzer
N
,
Zizioli
V
,
Mauri
M
,
Maggi
C
, et al
.
Validation of an enhanced recovery after surgery protocol in gynecologic surgery: an Italian randomized study
.
Am J Obstet Gynecol
.
2020
;
223
(
4
):
543.e1
543.e14
.
11.
Casarin
J
,
Bogani
G
,
Piovano
E
,
Falcone
F
,
Ferrari
F
,
Odicino
F
, et al
.
Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma
.
J Gynecol Oncol
.
2020
;
31
(
5
):
e64
.
12.
Soleymani majd
H
,
Ferrari
F
,
Gubbala
K
,
Campanile
RG
,
Tozzi
R
.
Latest developments and techniques in gynaecological oncology surgery
.
Curr Opin Obstet Gynecol
.
2015
;
27
(
4
):
291
6
.
13.
Bogani
G
,
Giannini
A
,
Vizza
E
,
Di Donato
V
,
Raspagliesi
F
.
Sentinel node mapping in endometrial cancer
.
J Gynecol Oncol
.
2024
;
35
(
1
):
e29
.
14.
Golia D’Augè
T
,
Cuccu
I
,
Santangelo
G
,
Muzii
L
,
Giannini
A
,
Bogani
G
, et al
.
Novel insights into molecular mechanisms of endometrial diseases
.
Biomolecules
.
2023
;
13
(
3
):
499
.
15.
Antonescu
I
,
Carli
F
,
Mayo
NE
,
Feldman
LS
.
Validation of the SF-36 as a measure of postoperative recovery after colorectal surgery
.
Surg Endosc
.
2014
;
28
(
11
):
3168
78
.
16.
Ardighieri
L
,
Palicelli
A
,
Ferrari
F
,
Bugatti
M
,
Drera
E
,
Sartori
E
, et al
.
Endometrial carcinomas with intestinal-type metaplasia/differentiation: does mismatch repair system defects matter? Case report and systematic review of the literature
.
J Clin Med
.
2020
;
9
(
8
):
E2552
.
17.
Di Donato
V
,
Giannini
A
,
Bogani
G
.
Recent advances in endometrial cancer management
.
J Clin Med
.
2023
;
12
(
6
):
2241
.
18.
Mueller
PS
,
Plevak
DJ
,
Rummans
TA
.
Religious involvement, spirituality, and medicine: implications for clinical practice
.
Mayo Clin Proc
.
2001
;
76
(
12
):
1225
35
.
19.
Rijnhart-de Jong
H
,
Haenen
J
,
Bol Raap
G
,
Jekel
L
,
Vossenberg
T
,
Bondarenko
O
, et al
.
Determinants of non-recovery in physical health-related quality of life one year after cardiac surgery: a prospective single Centre observational study
.
J Cardiothorac Surg
.
2020
;
15
(
1
):
234
.
20.
Rauck
RC
,
Swarup
I
,
Chang
B
,
Ruzbarsky
JJ
,
Dines
DM
,
Warren
RF
, et al
.
Preoperative patient expectations of elective reverse shoulder arthroplasty
.
J Shoulder Elbow Surg
.
2019
;
28
(
7
):
1217
22
.
21.
Sidenius
A
,
Manderson
L
,
Mogensen
O
,
Rudnicki
M
,
Møller
LMA
,
Hansen
HP
.
“But this is a good cancer:” Patient perceptions of endometrial cancer in Denmark
.
J Clin Nurs
.
2019
;
28
(
1–2
):
245
56
.
22.
Burrows
A
,
Pudwell
J
,
Bougie
O
.
Preoperative factors of endometrial carcinoma in patients undergoing hysterectomy for atypical endometrial hyperplasia
.
J Obstet Gynaecol Can
.
2021
;
43
(
7
):
822
30
.
23.
Lindfors
A
,
Järvholm
S
,
Dahm-Kähler
P
.
Health-related quality of life after robotic surgery for endometrial cancer: a prospective longitudinal one-year follow-up study
.
Arch Gynecol Obstet
.
2023
;
308
(
2
):
515
25
.
24.
Drymiotou
S
,
Dokmeci
M
,
Chandrasekaran
D
,
Jeyarajah
A
,
Brockbank
E
.
Impact of minimally invasive surgery on surgical outcomes for obese women with endometrial cancer following robotic surgery introduction; a single centre study
.
Int J Med Robot
.
2023
;
20
(
1
):
e2559
.
25.
Brodersen
F
,
Wagner
J
,
Uzunoglu
FG
,
Petersen-Ewert
C
.
Impact of preoperative patient education on postoperative recovery in abdominal surgery: a systematic review
.
World J Surg
.
2023
;
47
(
4
):
937
47
.
26.
Feldman
LS
,
Lee
L
,
Fiore
J
.
What outcomes are important in the assessment of Enhanced Recovery after Surgery (ERAS) pathways
.
Can J Anesth Can Anesth
.
2015
;
62
(
2
):
120
30
.
27.
Fahmer
N
,
Faller
H
,
Wöckel
A
,
Salmen
J
,
Heuschmann
PU
,
Meng
K
.
Patients’ perceived challenges, competencies, and supportive care needs during acute clinical treatment of breast or gynecological cancer
.
Psychooncology
.
2023
;
32
(
5
):
682
91
.
28.
Mangione
CM
,
Goldman
L
,
Orav
EJ
,
Marcantonio
ER
,
Pedan
A
,
Ludwig
LE
, et al
.
Health-related quality of life after elective surgery: measurement of longitudinal changes
.
J Gen Intern Med
.
1997
;
12
(
11
):
686
97
.
29.
Anthony
T
,
Jones
C
,
Antoine
J
,
Sivess-Franks
S
,
Turnage
R
.
The effect of treatment for colorectal cancer on long-term health-related quality of life
.
Ann Surg Oncol
.
2001
;
8
(
1
):
44
9
.
30.
Goetz
J
,
Maderbacher
G
,
Gerg
A
,
Leiss
F
,
Dullien
S
,
Zeman
F
, et al
.
Isokinetic knee muscle strength comparison after enhanced recovery after surgery (ERAS) versus conventional setup in total knee arthroplasty (TKA): a single blinded prospective randomized study
.
J Exp Orthop
.
2023
;
10
(
1
):
44
.
31.
Wang
SM
,
Moore
C
,
Keegan
E
,
Mayer
C
,
Litman
E
,
Das
KJH
, et al
.
Analysis of sociodemographic factors affecting ambulatory surgical center discharge patterns for endometrial cancer hysterectomies
.
J Minim Invasive Gynecol
.
2023
;
30
(
11
):
919
25
.
32.
Fotiou
A
,
Kokkali
K
,
Psomiadou
V
,
Iavazzo
C
.
Feasibility and safety of same-day discharge after robotic-assisted hysterectomy for endometrial cancer
.
Updat Surg
.
2023
;
75
(
5
):
1373
4
.
33.
Theunissen
M
,
Peters
ML
,
Schepers
J
,
Maas
JWM
,
Tournois
F
,
van Suijlekom
HA
, et al
.
Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery
.
Medicine
.
2016
;
95
(
26
):
e3980
.
34.
Agrafiotis
M
,
Galanou
A
,
Fletsios
D
,
Chassiotou
A
,
Chloros
D
,
Steiropoulos
P
.
Functional comorbidity index and health-related quality of life in patients with obstructive sleep apnea
.
Adv Respir Med
.
2022
;
90
(
1
):
9
16
.
35.
Higuita-Gutiérrez
LF
,
Velasco-Castaño
JJ
,
Jiménez Quiceno
JN
.
Health-related quality of life in patients with chronic kidney disease in hemodialysis in medellín (Colombia)
.
Patient Prefer Adherence
.
2019
;
13
:
2061
70
.
36.
Feng
X
,
Deng
A
,
Chen
J
,
Xiong
R
.
Health-related outcomes 6 months after integrated care of older people with stroke in 2 different primary care settings
.
Fam Pract
.
2023
:
cmad021
.
37.
Van Der Vlies
E
,
Vernooij
LM
,
Hamaker
ME
,
van der Velden
AMT
,
Smits
M
,
Intven
MPW
, et al
.
Frailty and health related quality of life three months after non-metastatic colorectal cancer diagnosis in older patients: a multi-centre prospective observational study
.
J Geriatr Oncol
.
2022
;
13
(
1
):
74
81
.
38.
AlAshqar
A
,
Ghazarian
M
,
Webster
EM
,
Upadhyay
A
,
Azodi
M
,
Schwartz
PE
, et al
.
Surgical and oncologic outcomes in surgically treated women 80 years and older with endometrioid endometrial cancer as a function of their comorbidities
.
Gynecol Oncol Rep
.
2023
;
49
:
101240
.
39.
Van Kooten
RT
,
Schutte
BAM
,
Van Staalduinen
DJ
,
Hoeksema
JHL
,
Holman
FA
,
van Dorp
C
, et al
.
Patient perspectives on consequences of resection for colorectal cancer: a qualitative study
.
Colorectal Dis
.
2023
;
25
(
8
):
1578
87
.
40.
Long
A
.
The healing process, the road to recovery and positive mental health
.
J Psychiatr Ment Health Nurs
.
1998
;
5
(
6
):
535
43
.
41.
Wang
D
,
Hu
Y
,
Liu
K
,
Liu
Z
,
Chen
X
,
Cao
L
, et al
.
Issues in patients’ experiences of enhanced recovery after surgery (ERAS): a systematic review of qualitative evidence
.
BMJ Open
.
2023
;
13
(
2
):
e068910
.
42.
Shao
W
,
Wang
H
,
Chen
Q
,
Zhao
W
,
Gu
Y
,
Feng
G
.
Enhanced recovery after surgery nursing program, a protective factor for stoma-related complications in patients with low rectal cancer
.
BMC Surg
.
2020
;
20
(
1
):
316
.
43.
Gujral
S
,
Avery
KNL
,
Blazeby
JM
.
Quality of life after surgery for colorectal cancer: clinical implications of results from randomised trials
.
Support Care Cancer
.
2008
;
16
(
2
):
127
32
.
44.
Elsherbini
N
,
Carli
F
.
Advocating for prehabilitation for patients undergoing gynecology-oncology surgery
.
Eur J Surg Oncol
.
2022
;
48
(
9
):
1875
81
.
45.
Di Donato
V
,
D’Oria
O
,
Giannini
A
,
Bogani
G
,
Fischetti
M
,
Santangelo
G
, et al
.
Age-adjusted Charlson comorbidity index predicts survival in endometrial cancer patients
.
Gynecol Obstet Invest
.
2022
;
87
(
3–4
):
191
9
.
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