Abstract / Summary
Enhanced Recovery After Surgery (ERAS) pathways integrate evidence-based perioperative interventions to accelerate recovery and reduce postoperative morbidity. This study evaluated the association between implementation of an ERAS pathway and postoperative outcomes among women undergoing elective gynecological surgery at a tertiary-care hospital in India. A retrospective before-and-after cohort study was conducted at a tertiary-care hospital in Pune, India, from January to December 2025. Women aged 18–70 years undergoing elective gynecological surgery for benign or oncological indications were included. The conventional-care cohort comprised patients treated from January to June 2025, while the ERAS cohort included patients treated from July to December 2025 following institutional ERAS implementation on 1 July 2025. Consecutive eligible records were reviewed, with 360 patients included in each cohort (total n = 720). Primary outcomes were length of hospital stay (LOS) and postoperative complications. Secondary outcomes included time to oral intake, time to ambulation, postoperative pain, 30-day readmission, specific postoperative complications, and hospitalization-related costs. Multivariable logistic regression was planned to evaluate factors associated with postoperative complications and prolonged hospital stay (> 3 days). Baseline demographic and operative characteristics were comparable between groups. Mean LOS was significantly shorter in the ERAS group than in the conventional-care group (2.8 ± 0.9 vs. 5.1 ± 1.4 days; p < 0.001). At least one postoperative complication occurred in 54 (15.0%) ERAS patients compared with 108 (30.0%) conventional-care patients ( p < 0.001). ERAS was associated with earlier oral intake (14.2 ± 4.6 vs. 32.5 ± 8.2 h; p < 0.001) and earlier ambulation (16.8 ± 5.1 vs. 36.2 ± 9.5 h; p < 0.001). Mean postoperative VAS pain score was lower with ERAS (3.2 ± 1.1 vs. 5.6 ± 1.4; p < 0.001). Thirty-day readmission occurred in 5.0% of ERAS patients compared with 8.9% of conventional-care patients ( p = 0.04). Surgical-site infection, postoperative ileus, and nausea/vomiting were also less frequent in the ERAS cohort. Mean hospitalization-related cost/charge was lower in the ERAS group (INR 48,500 ± 6,200 vs. 62,300 ± 8,500; p < 0.001). Implementation of an ERAS pathway was associated with faster postoperative recovery, shorter hospitalization, lower postoperative morbidity and pain, fewer 30-day readmissions, and lower hospitalization-related charges among women undergoing elective gynecological surgery. These findings support multidisciplinary ERAS implementation in gynecological surgical practice. However, the retrospective single-center before-and-after design and the absence of formal patient-level ERAS compliance measurement limit causal inference. Prospective multicenter studies with standardized compliance assessment and procedure-specific analyses are warranted.