Evaluating the Clinical Impact of an Enhanced Recovery After Surgery (ERAS) Program: A Quality Improvement and Practice Change Study at Al-hada Armed Forces Hospital

IntroductionEnhanced recovery after surgery (ERAS) is a proven perioperative framework designed to attenuate surgical stress and accelerate recovery.However, translating global ERAS evidence into localized practice requires bridging significant implementation gaps and modifying entrenched clinical habits.This study evaluates the clinical and operational impact of a multidisciplinary ERAS implementation model for laparoscopic cholecystectomy at a tertiary military hospital. MethodsThis quasi-experimental pre-and post-intervention quality improvement study at Alhada Armed Forces Hospital evaluated an ERAS protocol for elective laparoscopic cholecystectomy (aged 18-80 years, ASA I-III), comparing prospective post-intervention (n = 120) and retrospective baseline (n = 88) cohorts.Excluded patients included emergency cases, severe comorbidities, cognitive impairment, or open conversions (30 excluded; 208 analyzed).Interventions spanned three plan-do-study-act (PDSA) cycles featuring opioidreducing analgesia, standardized perioperative care, point-of-care checklists, and protocol-driven discharge.Clinical, economic, and satisfaction outcomes were extracted from hospital databases and SMS surveys, then analyzed in jamovi via Student's t-tests and Chi-square (χ2 ) tests (p < 0.05). ResultsAmong 208 analyzed patients (baseline: n = 88; ERAS: n = 120), ERAS implementation increased checklist compliance to 100.0% (mean: 72.1% ± 38.7%).Ambulatory day-case success increased from 0.0% to 27.5% (33/120; p < 0.0001), while mean length of stay (LOS) dropped from 4.33 ± 0.89 to 2.67 ± 1.15 days (t = 3.96, p = 0.0007).Implementation of the ERAS protocol saved 231 inpatient bed days across 77 patients, achieving total cost savings of Saudi Riyal (SAR) 346,500 [$92,400 United States Dollars (USD)].Postoperative complications were recorded in only one patient (1/120; 0.83%), with zero surgical site infections (0.0%).Patient satisfaction averaged 89.4% ± 3.3%, with a 30-day readmission rate of 0.83% (1/120). ConclusionIntegrating a file-embedded ERAS checklist into routine multidisciplinary care safely reduces LOS and expands same-day discharge for laparoscopic cholecystectomy without sacrificing safety, outcomes, or patient satisfaction.By maximizing existing infrastructure and structured patient education, this low-cost model provides a practical framework for healthcare systems seeking to optimize ambulatory capacity and operational efficiency.