Background <p>A standardized, multimodal Enhanced Recovery After Surgery (ERAS) protocol was implemented to improve postoperative outcomes in patients undergoing metabolic bariatric surgery (MBS). This quality improvement initiative evaluated the impact of a standardized, multimodal ERAS protocol on postoperative outcomes in MBS patients. Implemented at a community hospital where perioperative practices were inconsistent, this evidence-based pathway introduced a structured approach to perioperative care to enhance recovery and promote safer, more efficient outcomes.</p> Methods <p>A pre- and post-quality improvement study was conducted among adults undergoing MBS at a Midwestern community hospital following implementation of a structured ERAS protocol. Patients younger than 18 years and those with long-term opioid use were excluded. The Model for Evidence-Based Practice Change guided protocol development and implementation. Pre-implementation and post-implementation cohorts were compared across primary endpoints, including PONV incidence, opioid consumption, and length of stay (LOS). Mann–Whitney U tests, and chi-square or Fisher’s exact tests were used (<i>p</i> &lt; .05).</p> Results <p>ERAS implementation resulted in a significant reduction in postoperative opioid use (Mdn = 22.5 vs. 80.0 MME; U = 143.50, <i>p</i> &lt; .001). No significant differences were observed in PONV or LOS between groups. Protocol adherence was high (89.4%).</p> Conclusion <p>A structured, multimodal ERAS protocol was an effective quality improvement strategy for patients undergoing MBS at a community hospital. Standardizing perioperative care was associated with a significant reduction in opioid requirements without increasing PONV or LOS, supporting broader adoption of ERAS pathways in bariatric surgery programs.</p>