Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol Implementation in Major Gynecologic Procedures: A Prospective Case-Control Study

Background and objectives Enhanced recovery after surgery (ERAS) protocols have shown promise in improving patient outcomes across various surgical specialties. However, their adoption in gynecologic surgery has been relatively slow. This study aimed to evaluate the effectiveness of an ERAS protocol specifically tailored for major gynecologic procedures. Methods Following the Ethical Committee's approval and patient consent, a prospective case-control study was conducted over 18 months. The study included 180 women undergoing major gynecologic surgery, divided into Pre-ERAS (n=90) and ERAS (n=90) groups. The ERAS protocol incorporated preoperative education, carbohydrate loading, minimal bowel preparation, standardized anesthesia and fluid management, early mobilization, early feeding, and multimodal pain management, while Pre-ERAS patients received conventional treatment as per institutional protocol. Results ERAS patients experienced a faster return of bowel function, with eight patients (8.9%) having the first bowel sounds within four hours. All ERAS patients ambulated within 24 hours, compared to 52 patients (57.8%) in the Pre-ERAS group. Pain management was superior in the ERAS group, with 70 patients (77.8%) reporting a pain score of 3 on day three, versus 24 patients (26.7%) in the Pre-ERAS group. Postoperative complications were significantly reduced in the ERAS group (n=12; 13.3% vs n=28; 31.1%). Notably, 73 ERAS patients (81.1%) were discharged within seven days, compared to 35 patients (38.9%) in the Pre-ERAS group. Conclusion The study demonstrates that implementing an ERAS protocol in major gynecologic surgery leads to faster recovery, reduced postoperative complications, and shorter hospital stays.