A prospective comparative study of Enhanced Recovery After Surgery Protocol vs standard protocol of care in gynaecological surgeries

Hysterectomy ranks among the most frequently conducted major surgical interventions in the field of gynecology.

However, the availability of newer and less invasive treatment choices for gynecological conditions has led to a decline in the prevalence of total abdominal hysterectomy (TAH) with or without salpingo-oophorectomy, particularly in developed countries.

The complexity of inpatient gynecologic surgeries varies significantly from straightforward hysterectomies to intricate cytoreductive cancer surgeries.  Surgical interventions create significant stress on the body, disrupting homeostasis and triggering physiological changes.  This stress response leads to increased carbohydrate metabolism, elevated cardiac output, and insulin resistance, potentially resulting in relative hypoxia, impaired coagulation, and altered gastrointestinal and pulmonary function.  These physiological disturbances can delay recovery, prolong hospital stays and increase the risk of postoperative complications.  Extended hospitalization directly contributes to higher health care costs and longer sick leave, which adds to the overall socioeconomic burden. The primary objectives of preoperative and postoperative protocols are to promote faster recovery, minimize postoperative complications, and shorten hospital stays.

Kehlet first introduced the Enhanced Recovery After Surgery (ERAS) protocol, which represents a strategic approach aimed at optimizing perioperative care. The ERAS protocol aims to achieve homeostasis, minimize surgical trauma, reduction in inflammation and stress, and promote a faster recovery to baseline function after surgery. The core principles of ERAS encompass preoperative counseling, minimized perioperative fasting, prompt resumption of oral intake, and early postoperative mobilization, opioid-sparing pain management, regional anesthesia, minimally invasive surgical techniques, goal-directed IV fluid management, and restricted usage of surgical drains and tubes. Studies have shown that implementing ERAS protocols significantly reduces hospital length of stay and postoperative complications across various surgical specialties, including Colo-rectal urologic and gynecologic oncology, without raising the frequency of return to the healthcare system.

Thus, we have conducted this study to determine the Efficacy and outcome of the ERAS protocol in comparison to the standard protocol of care in major gynecological surgeries.