Objective  To analyze the current status and quality of existing obstetrics and gynecology enhanced recovery after surgery (ERAS) guidelines/consensus, understand the evidence-based practices in this field, and provide a basis for clinical decision-making.

Methods  A systematic search of PubMed, CNKI, and other databases, as well as NGC, SIGN, and websites of anesthesia societies domestically and internationally was conducted to obtain relevant guidelines and consensus on ERAS for gynecological surgery. The search was conducted from inception to July 1, 2023, and the AGREE II and RIGHT tools were used to analyze the current status and quality of the included guidelines/consensus, as well as to conduct a summary of the recommendations.

Results  A total of 5 guidelines and 10 consensus statements were included. The publication years were from 2018 to 2023, originating from the United States, China, Canada, and the United Kingdom. In the 6 areas evaluated using AGREE II, clarity (66.06%) scored highest, followed by scope and purpose (56.67%), involvement of stakeholders (42.02%), and editorial independence (37.64%) with scores above 30%. The scores for rigor of development (26.88%) and applicability (4.17%) were relatively low. The same items among different evaluators indicated good consistency. The results of the scores in each area were as follows: A-level 2, B-level 13, and no C-level. Two high-quality guidelines were selected. The average RIGHT reporting rate was 44.38%. Subgroup analysis showed that guidelines were higher than consensus statements in the areas of rigor of development and applicability (P  < 0.05), and that using GRADE was higher than not using (P < 0.05). The areas of rigor of development and clarity were higher in foreign guidelines than domestic guidelines (P < 0.05), and using evidence grading tools was higher than not using (P < 0.05). The summary of the recommendations showed that the quality of the evidence supporting the recommendations was uneven, and some recommendations were not specific enough.

Conclusion  The quality of the 15 included ERAS guidelines/consensus in obstetrics and gynecology is uneven, and 2 of them can be used as high-quality guidelines for clinical reference. The quality of evidence-based guidelines in foreign countries is higher, and the use rate of GRADE in foreign guidelines is high, most of which can provide clear recommendation strength and evidence level. Chinese guidelines/consensus are of lower quality compared to overseas, and methodology and report quality need further improvement. Overall, it is still necessary to strengthen the formulation of methods and reporting standards, improve the quality of evidence, and refine specific recommendations.

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