Implementation and Outcome Analysis of an Enhanced Recovery after Surgery Protocol at a Tertiary Care Hospital

Objective: To analyse the outcomes of surgeries performed at Aga Khan University Hospital using the enhanced recovery after surgery (ERAS) protocol since its implementation. Study Design: A cross-sectional study. Place and Duration of the Study: Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan, from July 2021 to July 2022. Methodology: This study included all major and intermediate elective general surgical procedures performed under the ERAS protocol between July 2021 and July 2022. Data were entered into SPSS version 19, covering patients followed ERAS criteria, types of surgeries, and perioperative analgesics received. Descriptive measures were reported as frequencies (%) of all categorical variables. Patients with low compliance (<70%) with the ERAS protocols were excluded. Results: A total of 52 cases were analysed, with more than 70% adherence to the ERAS protocol. Laparoscopic procedures accounted for 44 (84.6%) of these cases, with 36 (81.8%) patients discharged within 24 hours. In contrast, only 3 out of 8 patients undergoing open colorectal procedures were discharged within 3 days. This discrepancy suggests a gap in the efficacy of the ERAS protocol for open surgeries, which may be attributed to postoperative pain management and other procedural challenges. Conclusion: This study demonstrates that ERAS protocols can be highly effective, particularly for laparoscopic procedures. However, their success in open colorectal surgeries remains limited due to challenges, such as postoperative pain and the use of old surgical techniques.