Abdominal surgery is associated with considerable physiological stress, leading to postoperative pain, delayed gastrointestinal recovery, prolonged immobilization, and increased morbidity¹. Traditional perioperative management often includes prolonged fasting, liberal fluid administration, delayed feeding, and restricted mobilization, which may contribute to extended recovery times².

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care pathway aimed at minimizing surgical stress and supporting early return of function³. First introduced in colorectal surgery, ERAS protocols have now been widely adopted across multiple surgical specialties⁴. The core principles include preoperative counseling, minimal fasting, carbohydrate loading, avoidance of routine nasogastric tubes, multimodal analgesia, early mobilization, and early enteral nutrition⁵.

Surgical stress triggers neuroendocrine and inflammatory responses characterized by increased cortisol, catecholamines, and cytokine release⁶. This response contributes to insulin resistance, muscle catabolism, and impaired immune function⁷. ERAS pathways aim to attenuate these stress responses and maintain physiological homeostasis⁸.

Several randomized trials and meta-analyses have demonstrated that ERAS significantly reduces length of hospital stay and postoperative complications without increasing mortality or readmissions⁹ ¹⁰. Early mobilization and optimized pain control reduce pulmonary complications and thromboembolic events¹¹. Similarly, early enteral feeding enhances gastrointestinal motility and decreases infectious complications¹².

In abdominal surgery, especially colorectal, hepatobiliary, and upper gastrointestinal procedures, ERAS protocols have shown promising outcomes¹³. However, variability in implementation and adherence remains a concern¹⁴. Standardization and multidisciplinary collaboration are crucial for optimal results¹⁵.

Despite increasing adoption worldwide, data from developing healthcare settings remain limited¹⁶. Evaluating the effectiveness of ERAS in real-world hospital environments is essential to establish its feasibility and safety.

The present study aims to assess the impact of ERAS protocols on postoperative recovery parameters in patients undergoing elective abdominal surgery, comparing outcomes with conventional perioperative care.

Prospective comparative study conducted over 18 months at a tertiary care hospital. Study Population 120 adult patients undergoing elective abdominal surgery. Inclusion Criteria • Age 18–70 years • Elective open or laparoscopic abdominal surgery • ASA grade I–III • Informed consent provided Exclusion Criteria • Emergency surgeries • ASA grade IV and above • Severe hepatic/renal dysfunction • Pregnancy • Immunocompromised patients • Reoperation within 30 days Group Allocation • Group A (ERAS group): 60 patients managed under ERAS protocol • Group B (Conventional group): 60 patients managed with traditional perioperative care ERAS Protocol Components • Preoperative counseling • Reduced fasting (6 hrs solids, 2 hrs clear fluids) • Preoperative carbohydrate loading • No routine bowel preparation (unless indicated) • Multimodal opioid-sparing analgesia • Goal-directed fluid therapy • Early removal of drains • Early ambulation (within 12 hrs) • Early oral feeding (within 24 hrs) Outcome Measures • Time to ambulation (hours) • Time to first oral intake (hours) • Postoperative pain score (VAS) • Length of hospital stay (days) • Postoperative complications (Clavien-Dindo classification) • 30-day readmission rate Statistical Analysis Data analyzed using SPSS version 25. Continuous variables expressed as mean ± SD; categorical variables as percentage. Independent t-test and Chi-square test used. p < 0.05 considered significant.

Table 1: Demographic Characteristics

No significant demographic differences between groups.

Table 2: Time to Ambulation

ERAS significantly reduced time to ambulation.

Table 3: Time to Oral Intake

Early feeding achieved in ERAS group.

Table 4: Length of Hospital Stay

ERAS significantly reduced hospital stay.

Table 5: Postoperative Complications

Lower complication rate in ERAS group.

Table 6: 30-Day Readmission

No significant difference in readmission rates.

The present study demonstrates that ERAS protocols significantly enhance postoperative recovery in abdominal surgery. Reduced hospital stay observed in our study aligns with findings from Ljungqvist et al.¹⁷ and Thiele et al.¹⁸ who reported 2–3 day reductions in length of stay following ERAS implementation.

Early mobilization plays a critical role in preventing postoperative pulmonary complications and venous thromboembolism¹⁹. Our findings support those of Gustafsson et al.²⁰ who demonstrated improved functional recovery with early ambulation strategies.

Early enteral nutrition reduces insulin resistance and preserves gut integrity²¹. Meta-analyses by Greco et al.²² showed significant reductions in ileus and infections with ERAS pathways.

Lower complication rates in our ERAS group correspond with results reported in colorectal and hepatobiliary surgeries²³. Multimodal analgesia minimized opioid consumption, contributing to reduced ileus and earlier recovery²⁴.

Importantly, ERAS did not increase readmission rates, consistent with findings from international cohort studies²⁵.

These results reinforce that ERAS is safe, effective, and feasible in abdominal surgical practice.

ERAS protocols significantly reduce hospital stay, accelerate recovery, and decrease postoperative complications in abdominal surgery without increasing readmission rates. Adoption of ERAS pathways should be encouraged as a standard perioperative care approach.

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