Impact of ERAS implementation on the quality of recovery following robotic laparoscopic gynecological surgery: a randomized controlled trial

Background: In the gynecology field, robotic laparoscopic surgery is increasingly being used to enhance the quality of care. The Enhanced Recovery After Surgery (ERAS) program, which improves patient outcomes, is becoming the standard of care, but its impact on gynecological patients remains unclear. We compared the effect of ERAS implementation and conventional care for robotic gynecological surgery. Methods: This parallel-group, randomized controlled trial included patients aged 20-70 years undergoing robotic gynecological surgery at a single tertiary medical center in the Republic of Korea. Patients were randomized to conventional care and ERAS groups in a 1:1 ratio. The customized ERAS protocol encompassed minimized fasting, pre-emptive analgesia, transversus abdominis block, and early ambulation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24-h and 1-week postoperatively. Secondary outcomes included postoperative pain, ClavienDindo grade ≥ 3 complications, readmission, and length of hospital stay. Results: Of the 66 enrolled patients, data of 65 were analyzed (conventional care, n = 32; ERAS, n = 33). Compared with conventional care, ERAS resulted in a significantly better quality of recovery at 24-h (QoR-15 scores: 93 [71117] vs. 124 [103135], P < 0.001) and 1-week postoperatively (QoR-15 scores: 135 [131142] vs. 142 [136148], P = 0.002). Additionally, the ERAS group had less severe postoperative pain and a shorter length of hospital stay. Complication and readmission rates were comparable between the groups. Conclusions: ERAS implementation in robotic gynecological surgery enhanced the quality of recovery and provided better pain control than conventional care, without affecting patient safety.