Gastrointestinal-focused enhanced recovery after surgery compliance and restoration of post-operative bowel function in gynecological malignancies: a prospective cohort study

Background Restoring post-operative gastrointestinal (GI) function is key to overall recovery. While data on enhanced recovery after surgery (ERAS) compliance in gynecological oncology exist, the specific impact of GI-focused components on early bowel function remains understudied. Objectives The primary objective was to evaluate the rate of oral fluid tolerance at 6 h post-operatively in patients undergoing elective laparotomy for gynecological malignancies and determine the impact of GI-focused ERAS compliance on this outcome. Secondary objectives included evaluating post-operative complications, length of stay (LOS), and readmissions. Methods This prospective cohort study was conducted at a tertiary cancer center in India (February 2023–November 2024) with 165 patients. Fifteen GI-focused ERAS components were selected. Compliance was calculated as the percentage of components fulfilled per patient. The association between compliance and early oral tolerance was analyzed using logistic regression and receiver operating characteristic (ROC) analysis. Results The median compliance rate was 80% [interquartile range (IQR) 73.3%–86.6%]. Early oral tolerance was achieved in 56.4% of patients. On multivariate analysis, while individual components showed variation, overall high compliance was positively associated with early oral tolerance. ROC analysis identified a compliance threshold of 79% (AUC 0.749; sensitivity 60.2%, specificity 83.3%) as a significant predictor for early oral tolerance. However, higher compliance did not significantly reduce LOS or major complications in this cohort. Conclusion A compliance threshold of >79% in GI-focused ERAS components is associated with improved early oral tolerance in open gynecological oncology surgeries. While this did not translate to reduced LOS, likely due to non-medical discharge factors, targeting high compliance facilitates early physiological recovery.