The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: A retrospective study.

The enhanced recovery after surgery (ERAS) pathway was formulated with the aim to reduce surgical stress response, alleviate pain and guarantee the best-fit experience of patients' perioperative period. However, the application of ERAS in geriatric patients who underwent unicompartmental knee arthroplasty (UKA) was relatively lacking. We hypothesize that UKA patients can benefit from the ERAS protocol. A total of 238 patients were recruited in this retrospective study from August 2018 to December 2021, and Oxford phase III UKA was applied to all patients. ERAS pathway included nutrition support, anesthesia mode, interoperative temperature, and blood pressure control, application of tranexamic acid, early initiation of oral intake and mobilization, and pain management. Demographic data, operation-relative variables, and postoperative complications were analyzed. Forgotten Joint Scores, Oxford Knee Score, Lysholm score, numerical rating scale, and knee range of motion were introduced to estimate the activity function and pain of surgical knee, and these variables were compared between the 2 groups. There were 117 patients in the ERAS group and 121 patients in the traditional group, respectively. The ERAS group had a shorter length of surgical incision and less intraoperative blood loss. Postoperative hemoglobin and albumin of patients in the ERAS group were better than those in the traditional group (P < .05), after 17.0 ± 10.8 months follow-up, the numerical rating scale, Lysholm, Oxford Knee Score, Forgotten Joint Scores, and knee range of motion of patients in the ERAS group were significantly better than the traditional group. The length of hospital stay for patients who underwent ERAS was 11.7 ± 3.8 days and the postoperative complication rate was lower for the ERAS group patients (P = .000 and 0.031). ERAS can reduce the length of hospital stay, and patients can achieve excellent postoperative knee function. The formulation and implementation of the ERAS protocol require good collaboration across multiple disciplines, as well as a deep understanding of the existing clinical evidence and the concept of the ERAS program.

Application of enhanced recovery after surgery during the perioperative period in infants with Hirschsprung's disease-Amulti-center randomized clinical trial.

The aim of this study was to evaluate short-term outcomes of patients undergoing mini-invasive rectal resection within an ERAS (enhanced recovery after surgery) protocol. Aprospectively managed database of patients undergoing rectal operations performed at our department between January 2015 and April 2020 was retrospectively analyzed. An ERAS protocol was implemented into clinical practice at our department in April 2016 and mini-invasive rectal procedures in May 2016. The ERAS group consisted of all patients who underwent mini-invasive rectal resections or amputations within the ERAS protocol. The control group consisted of patients who underwent open procedures and received standard perioperative care. The extracted data included basic patient characteristics, surgical data, postoperative recovery parameters, 30-day morbidity, length of postoperative stay and 30-day rehospitalization. Atotal of 110 patients were included in the study: 67 patients in the ERAS group and 43 in the control group. Within the ERAS group 47 patients underwent robotic procedures and 20 had laparoscopic procedures. Patients in the ERAS group had significantly better clinical and laboratory recovery parameters except for postoperative nausea and vomiting. Asignificantly lower incidence of paralytic ileus (20.9% vs. 3%) and ashorter length of postoperative stay (13 days vs. 9 days) was found in the ERAS group. The rehospitalization rate and 30-day morbidity were not different between the ERAS and control group. Implementation of the ERAS protocol in combination with mini-invasive approaches leads to better short-term postoperative outcomes after rectal surgery.

(Objectives) The Enhanced Recovery After Surgery (ERAS) protocols are standardized and multimodal perioperative care pathways designed to improve surgical outcomes by minimizing stress response and inflammation following surgery. First adopted in colorectal surgery, ERAS is now being employed in various other types of surgeries, most recently in patients undergoing radical cystectomy (RC). Implementation of ERAS protocols resulted in reductions in perioperative complication rates and length of hospital stay (LOS). However, information on the adoption of ERAS in patients undergoing RC in Japan is limited. The objective of this study was to evaluate the safety and efficacy of ERAS implemented in the Toyohashi Municipal Hospital in 2017 for the management of patients with RC. (Patients and methods) This was a retrospective study of 103 patients who underwent RC and urinary diversion from January 2012 to March 2019. Of the 103 patients, 71 underwent surgery prior to the introduction of the ERAS were allocated to the 'traditional' group, while 32 were exposed to the ERAS protocol were allocated to the 'ERAS' group. In this study, ERAS included no bowel preparation, preoperative carbohydrate loading, preoperative fluid reduction, preoperative fasting, reduced drainage use, no nasogastric intubation, and early postoperative drinking and eating. A comparative analysis was performed to evaluate LOS and postoperative complication rate (Clavien classification ≥2) after RC between the 'traditional' and 'ERAS' groups. (Results) Patient characteristics and intraoperative variables such as median age, sex, body mass index, clinical and pathological cancer stage, amount of bleeding, need for transfusion, and technique of urinary diversion did not differ between groups. However, duration of surgery was significantly shorter in the ERAS group than in the traditional group (402 min vs. 470 min; P = 0.03). Further, rate of complication was significantly lower (43.8% vs. 67.6%; P=0.03) and LOS after RC was significantly shorter (21 days vs. 28 days; P<0.001) in the ERAS group compared to the traditional group. Moreover, ERAS was an independent factor affecting shorter LOS after RC (OR, 5.22; 95% CI, 1.52-17.90; P = 0.009) in multivariate analyses. (Conclusions) It is possible that the ERAS protocol adopted in this study reduced the LOS and postoperative complication rate after RC at this site in Japan.

BackgroundJapan has one of the highest five-year relative survival rates for colorectal cancer in the world, with its own traditions of perioperative care and a unique insurance system. The benefits of enhanced recovery after surgery (ERAS) protocols in the Japanese population have yet to be clarified.MethodsWe evaluated 352 consecutive cases of colorectal cancer resection at Tokyo Metropolitan Bokutoh Hospital between July 2009 and November 2012. Of these, 95 cases were performed according to traditional protocols (traditional group), and 257 according to ERAS protocols (ERAS group), which were introduced to the hospital in July 2010. Primary endpoints included length of postoperative hospital stay, postoperative short-term morbidity, and rate of readmission within 30 days. Intensive pre-admission counselling, no pre- and postoperative fasting (provision of oral nutrition), avoidance of sodium/fluid overload, intraoperative warm-air body heating, enforced postoperative mobilization, and multimodal team care were among the main changes brought about by the introduction of ERAS protocols.ResultsThe median (interquartile range) length of postoperative hospital stay was 10 (10–12.75) days in the traditional group and seven (6–8) days in the ERAS group, i.e., a three-day reduction (p < 0.05) in the ERAS group. Moreover, the proportion of patients discharged within one week dramatically increased from 1 % to 77 % in the ERAS group. The overall incidence of grade 2 and 3 postoperative complications according to the Clavien-Dindo classification was 9.5 % in the traditional group and 9.3 % in the ERAS group, and 30-day readmission rates were 8.3 % and 6.6 % in the traditional and ERAS groups, respectively. There were no significant differences between the two groups. Although operative time and blood loss did not differ significantly between the two groups, the volume of intraoperative infusion was significantly decreased in the ERAS group (p < 0.05), possibly due to ERAS recommendations to avoid dehydration (i.e., avoidance of sodium/fluid overload, no preoperative fasting).ConclusionERAS protocols for colorectal surgery helped reduce the length of postoperative hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible and effective in Japanese settings as well.

Objective To investigate the application value and feasibility of enhanced recovery after surgery (ERAS) in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed. All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia. The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group. Observing indicators included: (1) enteral and parenteral nutritional support treatments; (2) nutrient indexs: levels of serum albumin (Alb) and prealbumin; (3) the recovery of gastrointestinal function: time to anal exsufflation and defecation; (4) postoperative complications and the grading according to Clavien standard; (5) duration of postoperative hospital stay and treatment expenses; (6) risk factors affecting postoperative complications by multivariate analysis; (7) independent risk factors affecting occurrence rate of postoperative complications by univariate analysis. Measurement data with normal distribution were presented as ±s and analyzed using the t test. Non-normal distribution data were analyzed by the Wilcoxon rank sum test. Comparison of repeated data was analyzed by the repeated measures ANOVA. Categorical variables were analyzed using the chi-square test or Fisher's exact probability. The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively. Results (1) During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn't receive oral intake at postoperative day 1, 26 proceeded the intravenous rehydration at postoperative day 4 due to calorie intake less than 80% of calorie requirement, and enteral nutritional support treatment was well-tolerated in the control group. (2) Comparison of nutrient indexs: the levels of serum Alb and prealbumin at postoperative day 1, 3 and 5 were (37.2±3.9)g/L, (39.1±3.5)g/L, (38.5±3.0)g/L and (0.20±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the ERAS group, (37.7±2.8)g/L, (39.0±3.6)g/L, (38.4±3.8)g/L and (0.18±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the control group, respectively, showing no significant difference in the postoperative changing trends between the 2 groups (F=0.357, 0.453, P>0.05). (3) The recovery of gastrointestinal function: time to first anal exsufflation and first defecation were (2.1±0.8)days and (3.4±1.2)days in the ERAS group, (3.2±0.9)days and (5.5±1.5)days in the control group, respectively, showing significant differences between the 2 groups (t=-10.505, -13.174, P 0.05). Eight and 10 patients in the ERAS and control groups underwent gastrointestinal decompression, 6 and 8 patients in the ERAS and control groups underwent retreatment in the intensive care unit (ICU), 3 and 2 patients in the ERAS and control groups were readmitted to the hospital at 3 weeks after discharge, with no significant difference in the above indexes (χ2=0.185, 2.892, P>0.05). (5)The duration of postoperative hospital stay and treatment expenses were (6.8±2.4)days and (25 088±10 336)yuan in the ERAS group, (11.1±3.4)days and (38 819±14 854)yuan in the control group, showing significant differences between the 2 groups (t=-12.782, -9.452, P 10%, tumor staging, tumor differentiation, neoadjuvant chemotherapy and time of food intake were risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the univariate analysis (χ2=2.484, 2.333, 0.061, 8.553, 2.459, 0.163, 3.462, P 10%, tumor staging and neoadjuvant chemotherapy were independent risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the multivariate analysis (OR=0.365, 10.761, 0.290, 8.140, 95% confidence interval : 0.198-0.671, 4.122-28.095, 0.130-0.645, 3.946-16.791, P 0.05). Conclusions ERAS in the esophageal minimally invasive surgery for esophageal cancer is safe and feasible, with the advantages of shorter recovery time of gastrointestinal function and duration of hospital stay, lower treatment expenses and a better application value compared with traditional treatment. Key words: Esophageal neoplasms; Thoracoscopic and laparoscopic esophagectomy; Enhanced recovery after surgery

To investigate the clinical value of enhanced recovery after surgery (ERAS) protocols for children with neuroblastoma (NB). This retrospective review was conducted by using the electronic medical records of 48 children with retroperitoneal localized NB who underwent tumor resection (surgery for treatment, not diagnosis) between October 2016 and September 2021. The ERAS protocols for NB excision were implemented in 28 children (ERAS group), while 20 children received traditional care (TRAD group). The same group of pediatric surgeons performed all the tumor resections. Intraoperative fluid infusion, the extent of NB resection, time of early ambulation and time of first flatus, time to total enteral nutrition (TEN) after surgery, abdominal drainages, nasogastric tubes and urinary catheters used and duration, the Face/Legs/Activity/Cry/Consolability (FLACC) quantitative table on a postoperative day 1 (POD1), 3, 5, length of stay after surgery (LOS), hospitalization expense, postoperative complications, parental satisfaction rate and readmission rate of surgical wards within 30days after operation were analyzed. The median postoperative period of early mobilization, first flatus, TEN, LOS and total cost during hospitalization were 1.0days, 2.0days, 5.5days, 9.0days and 33,397.3 yuan in the ERAS group and 3.0days, 3.0days, 7.0days, 11.0days and 38,120.3 Yuan in the TRAD group, respectively (all p < 0.05). Median intraoperative fluid volume was 5.0mL/kg/h compared to 8.0mL/kg/h and the magnitude of decrease in FLACC scores from POD1 to POD5 was greater in the ERAS group (all p < 0.05). Abdominal drainages, urinary catheters and nasogastric tubes were removed earlier in the ERAS group (p < 0.05). The satisfaction of parents in the ERAS group was slightly higher, but the difference was not statistically significant (P = 0.762). There were no marked differences between the two groups in aspects of the extent of NB resection, operation-related complications and 30-day readmissions (all P = 1.000). Application of ERAS protocols in localized retroperitoneal NBs resection in children is feasible and safe. However, applying ERAS protocols in the surgical resection of solid tumors in children still requires much more research, especially randomized prospective research.

ABSTRACTBackground:Patients having abdominal procedures might benefit from Enhanced Recovery After Surgery (ERAS) protocols, which are a comprehensive approach to perioperative care intended to reduce surgical stress, speed recovery, and enhance overall results. Throughout the preoperative, intraoperative, and postoperative stages, these evidence-based methods prioritize patient-centered, interdisciplinary approaches. The effectiveness of ERAS protocols in elective abdominal operations is assessed in this research in comparison to standard care.Materials and Methods:In total, 150 patients scheduled for elective abdominal procedures participated in a prospective randomized research. They were divided into two groups: 75 patients in the ERAS protocol group and 75 patients in the standard treatment group. While the conventional group got standard treatment procedures, the ERAS group received interventions such as early mobilization, opioid-sparing analgesia, preoperative carbohydrate loading, and early enteral feeding. Postoperative complication rates, duration of hospital stay, and recovery of bowel function were the main outcomes. Readmission rates and patient satisfaction were secondary objectives. Independent t-tests and Chi-square tests were used to examine the data, with a significance level of P < 0.05.Results:The average hospital stay for patients in the ERAS group was shorter (4.6 ± 1.1 days) than that of patients in the traditional treatment group (7.9 ± 2.3 days, P < 0.001). The ERAS group recovered their bowel function in 2.3 ± 0.8 days, which was considerably faster than the traditional group (4.1 ± 1.5 days, P < 0.001). The ERAS group had less postoperative complications (10%) than the traditional group (28%, P = 0.02). Furthermore, compared to 80% in the traditional group, 95% of patients in the ERAS group had good satisfaction levels (P = 0.03).Conclusion:By decreasing hospital stays, speeding the return of bowel function, and increasing patient satisfaction while lowering complications, ERAS procedures dramatically improve recovery in elective abdominal surgery. These results lend credence to the idea that ERAS should be included into standard surgical procedures in order to improve patient outcomes. Its usefulness in other surgical fields should be investigated in future studies.

Implementation of enhanced recovery after surgery in patients undergoing radical cystectomy: A retrospective cohort study

BackgroundEnhanced recovery after surgery (ERAS) protocols are now well-known to be useful for elective colorectal surgery, as they result in shorter hospital stays without adversely affecting morbidity. However, the efficacy and safety of ERAS protocols for patients with obstructive colorectal cancer have yet to be clarified.MethodsWe evaluated 122 consecutive resections for obstructive colorectal cancer performed between July 2008 and November 2012 at Tokyo Metropolitan Bokutoh Hospital. Patients with rupture or impending rupture and those who received simple colostomy were excluded. The first set of 42 patients was treated based on traditional protocols, and the latter 80 according to modified ERAS protocols. The main endpoints were length of postoperative hospital stay, postoperative short-term morbidity, rate of readmission within 30 days, and mortality. Differences in modified ERAS protocols relative to traditional care include intensive preoperative counseling (by both surgeons and anesthesiologists), perioperative fluid management (avoidance of sodium/fluid overload), shortening of postoperative fasting period and early provision of oral nutrition, intraoperative warm air body heating, enforced postoperative mobilization, stimulation of gut motility, early removal of urinary catheter, and a multidisciplinary team approach to care.ResultsMedian (interquartile range) postoperative hospital stay was 10 (10–14.25) days in the traditional group, and seven (7–8.75) days in the ERAS group, showing a 3-day reduction in hospital stay (p < 0.01). According to the Clavien-Dindo classification, overall incidences of grade 2 or higher postoperative complications for the traditional and ERAS groups were 15 and 10% (p = 0.48), and 30-day readmission rates were 0 and 1.3% (p = 1.00), respectively. As for mortality, one patient in the traditional group died and none in the ERAS group (p = 0.34).ConclusionModified ERAS protocols for obstructive colorectal cancer reduced hospital stay without adversely affecting morbidity, indicating that ERAS protocols are feasible for patients with obstructive colorectal cancer.

Enhanced recovery after surgery (ERAS) for spinal surgery is new; specifically, an ERAS program for elderly patients is lacking. Geriatric patients have special characteristics that result in further harm by surgical stress. ERAS interventions are designed to improve recovery after surgery and can result in substantial benefits in clinical outcomes and cost-effectiveness. We aimed to determine whether ERAS significantly improved satisfaction and outcomes in elderly patients with long-level lumbar fusion. Patients >70 years old with lumbar disc herniation or lumbar spinal stenosis who underwent lumbar fusion of ≥3 levels from July 2019 to June 2021 (ERAS group) and from January 2018 to June 2019 (non-ERAS group) were enrolled. Demographic, comorbidity, and surgical data were collected from electronic medical records. ERAS interventions were categorized as preoperative, intraoperative, and postoperative. We also evaluated primary outcome, surgical complications, and length of stay (LOS). The study included 154 patients, 72 in the ERAS group and 82 case-matched patients in the non-ERAS group. Overall, ERAS pathway compliance was 91%. There were no significant differences in readmission and mortality rates at 30-day follow-up between the ERAS and non-ERAS groups. Statistically significant decreases were observed in the ERAS group in complications (6 in ERAS group vs. 19 in non-ERAS group, P= 0.013) and LOS (17.74 ± 5.56 days in ERAS group vs. 22.13 ± 12.21 days in non-ERAS group, P= 0.041). Multivariable linear regression showed that implementation of ERAS (P= 0.002) was correlated with LOS. Multivariable logistic regression showed that implementation of ERAS (P= 0.004) was correlated with complications. The ERAS protocol used in elderly patients after long-level lumbar fusion surgery was safe and associated with incremental benefits regarding complications and LOS.

Enhanced Recovery after Surgery (ERAS) is a multimodal pathway to overcome the deleterious effect of perioperative stress, and has been applied to different surgeries including liver resection surgery. Explorative studies have shown the safety of some ERAS measures in liver transplantation patients, although no consensus was reached. This study aimed to evaluate the effect of ERAS protocols compared with conventional care in patients undergoing liver transplantation. All patients (aged 16-70) undergoing liver transplantation for their first time in our centers between January 2016 and July 2019 were retrospectively reviewed and included into this cohort study. They were divided into ERAS group and conventional group depending on the perioperative protocols. Operative time, anhepatic phase time, intraoperative blood loss, intraoperative hypothermia, Surgical Intensive Care Unit (SICU) stay, postoperative complications, pain score, postoperative hospital stay, and mortality were compared between the two groups. A total of 40 and 53 patients were included in the ERAS and conventional groups, respectively. The ERAS group had shorter SICU stay (2 vs. 4 days, p<0.001) and postoperative hospital stay (14.5 vs. 16 days, p<0.001) compared with the conventional group. Intraoperative hypothermia rate, postoperative pulmonary complications rate, and postoperative pain score were lower in the ERAS group (p<0.05). There were no differences in operative time, anhepatic phase time, blood loss, mortality, reintubation, lower extremity venous thrombosis and other complications incidence between the two groups. ERAS procedures effectively improved the patients' recovery, alleviated the suffering and pulmonary complications, and reduced SICU stay and postoperative hospital stay, without increasing incidence of other complications or reintubation. As a safe and feasible choice, ERAS protocols may also have some socioeconomic advantages, which should be addressed in further prospective cohort or clinical trial studies.

Background: Caesarean Section is a commonly performed surgical procedure in obstetric practice, with its incidence rising every year. This increase has led to higher bed occupancy and cost burdens. Conventional Caesarean Sections have several drawbacks, including patients being kept nil per oral overnight before surgery and for 12-24 hours after surgery, immobilization for up to 24 hours or more, continuation of catheter use for 24 hours or more, and the use of opioid-based anesthetics. To address these issues, Enhanced Recovery after Surgery (ERAS) has been introduced. ERAS consists of multimodal pathways during the pre-, intra-, and post-operative periods. Numerous clinical trials, systematic reviews, and meta-analyses have shown that applying ERAS in Caesarean delivery reduces the length of hospital stay, decreases the use of opioid-based anesthetics, improves patient satisfaction, reduces post-operative pain scores, and increases compliance with breastfeeding. Objectives: To determine the outcome of Enhanced Recovery after Surgery (ERAS) pathway in Caesarean Delivery. Methodology: This was a prospective observational study conducted at Paropakar Maternity and Women’s Hospital. Total duration of study period was 3 months from July 2024 to September 2024. A total of 106 patients meeting the inclusion criteria were included in the study. Those receiving care as per the ERAS protocols and standard conventional protocols were observed throughout pre, intra and post-operative period. The two groups were compared in terms of demographic characteristics, intravenous fluid requirement, duration of surgery, length of hospital stay, post-operative pain scores and other post-operative characteristics such as nausea, vomiting, headache, urinary retention, hospital readmission and neonatal outcome. Results: Total of 106 patients were included in the study with 53 in each of ERAS and SC group. In this study, there was no statistical difference in age group, Body Mass Index (BMI), co morbid conditions, gravidity, duration of gestation, indication of CS, duration of surgery and estimated blood loss. The average amount of intravenous fluid required intra operatively in ERAS group was 1350 ml and in SC group was 1650 ml with difference of 300 which was statistically significant, p &lt; .001. The mean length of post-operative hospital stay was 54 hrs. in ERAS group and 71 hrs. in SC group with difference of 17 hrs. which was statistically significant with p = 0.023. The mean post-operative score in ERAS group on Day 0, Day 1 and Day 2 were lower than in SC group with p value &lt; .001. There was no significant difference in post-operative complications between two groups. Conclusion: This study showed that implementation of ERAS protocol is associated with decrease in intra operative fluid requirement, decrease in post-operative length of hospital stay and is associated with significant difference in post-operative pain with use of multi modal analgesia. ERAS can be implemented in Caesarean delivery for addressing the issues of prolonged immobilization, delayed discharge, increased bed occupancy and many more issues associated with it.

Enhanced Recovery After Surgery (ERAS) protocols have shown benefits in various surgical specialties. However, their impact on metabolic and bariatric surgery (MBS) outcomes in the Middle East remains understudied, despite the increasing number of MBS in the region. This study aimed to evaluate the effects of implementing an ERAS protocol on patients undergoing primary MBS in a Middle Eastern population. We conducted a retrospective analysis from patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between January 2019 and December 2023. The ERAS protocol was implemented in October 2021. The primary outcomes evaluated were postoperative complications and length of stay (LOS). Mann-Whitney U and Fisher's Exact tests were used to evaluate differences in LOS and rates of serious complications, respectively, between non- and ERAS implementation groups. A total of 1802 patients were included in the study, with 913 in the non-ERAS group and 889 in the ERAS group. Baseline characteristics showed no significant differences between groups in age (non-ERAS: 35.02 ± 11.20years vs ERAS: 34.31 ± 11.32years, p = 0.165) or gender distribution (non-ERAS: 59.15% female vs ERAS: 65.80% female, p = 0.004). Mean preoperative Body Mass Index (BMI) was similar (non-ERAS: 42.75 ± 6.25kg/m2 vs ERAS: 42.38 ± 6.65kg/m2, p = 0.029). Procedure distribution was comparable, with SG accounting for 59.26% in non-ERAS and 71.20% in ERAS groups (p < 0.001). Obesity related diseases such as diabetes (non-ERAS: 22.02% vs ERAS: 20.58%, p < 0.001) and hypertension (non-ERAS: 19.61% vs ERAS: 14.29%, p < 0.001) were significantly lower in the ERAS group. After ERAS implementation, the overall mean LOS decreased significantly from 42.7h to 33.4h (p < 0.001) representing a 21.9% reduction. This reduction was consistent across both SG (24.9% decrease, p < 0.001) and RYGB (15.7% decrease, p < 0.00) procedures. The rate of major complications (Clavien-Dindo grade III-IV) within 30days decreased from 5.3% in the non-ERAS group to 2.5% in the ERAS group (OR 0.46, 95% CI 0.28-0.75, p < 0.001). This reduction was more pronounced in RYGB patients (8.4% to 3.8%, p = 0.02) compared to SG patients (3.8% to 1.9%, p = 0.33). Specific complications showing notable reductions in the ERAS group included superficial incisional surgical site infection (0.11% ERAS vs. 0.99% non-ERAS, p = 0.021) and acute renal failure (0% vs. 0.11%, p < 0.001). ERAS protocol significantly reduced major postoperative complications and length of stay in a Middle Eastern population, despite similar baseline characteristics between groups. These findings support the adoption of ERAS protocols in bariatric centers to enhance patient outcomes across the region.

This retrospective observational study aimed to evaluate the incidence of surgical site infection (SSI) in the era of enhanced recovery after surgery (ERAS) and the effect of ERAS on postoperative outcomes. Totally 1,276 patients (565 in ERAS group and 711 in non-ERAS group) who underwent operations at the department of general surgery during 2017–2021 were included. Risk factors were identified via logistic regression analysis and meta-analysis of all relevant published studies was performed. Subsequently, propensity score matching was used to match different risk factors. Overall, 40 patients were diagnosed with SSI, and the pooled incidence of SSI was 3.13%. In total, 14 (2.48%) and 26 (3.66%) patients in the ERAS and non-ERAS groups, respectively, were diagnosed with SSI (P = 0.230). Among patients for whom the ERAS protocol was adopted, 7 independent risk factors of SSI were identified. After propensity score matching, in patients without SSI, the number of hospital days was significantly lower in the ERAS group than in the non-ERAS group (2 [2, 5] vs. 3 [2, 7], P = 0.005), whereas in patients with SSI, the number of hospital days was similar between the ERAS and non-ERAS groups. ERAS had no effect on the incidence of SSI but could significantly accelerate the discharge of uninfected patients. In the era of ERAS, SSI incidence was affected by the type of surgery; number of postoperative hospital days; type of incision; serum hemoglobin, total protein, and albumin levels; and antibiotic prophylaxis. Furthermore, these results will significantly affect the implementation of the ERAS protocol and optimal preoperative management.