Enhanced Recovery After Surgery (ERAS) Guidelines in Emergency General Surgery: A Prospective Evaluation of Feasibility and Clinical Outcomes in a Developing Country

Abstract

Objective: This study aimed to evaluate the suitability and clinical impact of a tailored ERAS protocol in emergency general surgery within a resource-constrained low- and middle-income country (LMIC) setting. The primary focus was on outcomes such as hospital length of stay and postoperative complications. 

Study Design: Prospective observational study 
Place and Duration of Study: This study was conducted at the Emergency General Surgery of a Tertiary Care Center between January 2024 and December 2024. 

Methods: We performed a 12-month prospective observational study involving 150 consecutive adult patients undergoing emergency general surgery at a tertiary care center. Patients were divided into an ERAS group (n=75), managed with adapted emergency-specific protocol, and a control group (n=75) receiving standard postoperative care. The ERAS protocol included preoperative optimization if feasible, early mobilization, multimodal analgesia, early oral intake, and standardized discharge criteria. The primary outcome was length of hospital stay (LOH). Secondary outcomes included postoperative complications (Clavien-Dindo classification), time to first bowel movement, pain scores (Visual Analog Scale), and 30-day readmission rates. Feasibility was inferred as compliance with protocol elements. 

Results: ERAS implementation was feasible, with a mean compliance rate of 78%. Median LOH was significantly shorter in the ERAS group (5 vs. 8 days, p<0.001). Postoperative complication rates were lower in the ERAS group (21.3%) compared to controls (37.3%) (p=0.029), particularly for surgical site infections and ileus. Time to first bowel movement was shorter in the ERAS group (2.8 vs. 4.1 days, p<0.001). While pain scores were similar on postoperative day 1, they were significantly lower in the ERAS group from day 2 onward. The 30-day readmission rate was lower in the ERAS group (6.7% vs. 13.3%), though not statistically significant (p=0.178). 

Conclusion: The implementation of tailored ERAS protocol in resource constrained settings is feasible in emergency general surgery and is associated with shorter hospital stay, reduced complications, early recovery of bowel activity, and improved pain control. These findings support the broader adoption of ERAS in the EGS setting in under resourced hospitals.