Effectiveness of ERAS Protocol in Gynaecological Surgeries: Experience at a Tertiary Care Centre in India

Enhanced recovery after surgery (ERAS) is a standardised perioperative care protocol which targets the elements that delay the postoperative recovery, so as to achieve early and uneventful recovery.

Use of a standardised protocol is associated with more predictable perioperative treatment process. Although, widely used in other surgical specialities, there is a paucity of Indian data regarding implementation of ERAS protocol in patients undergoing gynaecological surgeries. This study was planned to assess the feasibility and impact of modified ERAS protocol implementation on perioperative recovery in patients undergoing surgery for proven or suspected gynaecological malignancy.

This is a prospective randomised cohort study conducted at Surgical Oncology Department of a tertiary care hospital in India from 1 January 2018 to 31 December 2021. Patients undergoing laparotomy for proven or suspected gynaecological malignancy were randomly divided into ERAS protocol group and standard perioperative care group. Postoperative outcomes data were collected in a predefined proforma and analysed using standard statistical tools.

A total of 279 patients were included in the study, 141 patients under standard perioperative care group and 138 patients under ERAS protocol group. There was significant reduction in median length of stay (LOS) in ERAS group 3.23 days versus 5.37 days (P < 0.0001), as compared to standard care group. Early return of bowel function 28.17 h versus 32 h (P = 0.0021), and early resumption of normal diet was noted in ERAS group 29.74 h versus 33.87 h (P = 0.0038) as compared to standard care group. Surgical site infection rates were significantly low in ERAS group 2.17% versus 9.92% (P = 0.010) as compared to standard care group. No statistically significant difference noted with regards to other complications like postoperative vomiting and deep vein thrombosis. Also, there was no significant difference noted in readmission rates under 30 days in both the groups (0.72% vs. 2.12%, P = 0.624).

Implementation of modified ERAS protocol significantly reduces LOS and improves postoperative recovery in patients undergoing gynaecological surgeries without any increase in complication rates.