IMPACT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOL ON POSTOPERATIVE RECOVERY IN PATIENTS UNDERGOING TOTAL ABDOMINAL HYSTERECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY.
Background: Hysterectomy remains one of the most commonly performed major gynaecological procedures worldwide for the management of benign uterine disorders and selected premalignant and malignant conditions. Despite significant advances in surgical techniques and perioperative care, conventional postoperative management following total abdominal hysterectomy is frequently associated with delayed ambulation, prolonged fasting, increased postoperative pain, delayed gastrointestinal recovery, higher complication rates, and extended hospitalization. These factors contribute to increased healthcare expenditure and delayed return to normal daily activities. Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based perioperative care pathway designed to attenuate the physiological stress response to surgery, reduce postoperative morbidity, facilitate earlier recovery, and improve patient satisfaction. Although ERAS protocols have demonstrated substantial benefits in colorectal and other surgical specialties, evidence regarding their effectiveness in abdominal hysterectomy, particularly in tertiary care hospitals, has remained limited. Aim: To evaluate the effectiveness of the Enhanced Recovery After Surgery (ERAS) protocol in improving postoperative recovery among women undergoing total abdominal hysterectomy. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Kanyakumari Government Medical College, Asaripallam, Nagercoil, from July 2012 to July 2013. Fifty women aged between 40 and 60 years who underwent elective total abdominal hysterectomy were enrolled using predefined eligibility criteria. All participants received standardized perioperative management based on ERAS principles including preoperative counselling, shortened fasting, optimized fluid therapy, multimodal analgesia, early oral feeding, early ambulation, and early catheter removal. Demographic characteristics, operative details, postoperative recovery parameters, gastrointestinal recovery, postoperative complications, analgesic requirement, and duration of hospital stay were recorded. Statistical analysis was performed using SPSS software version 23. Continuous variables were expressed as mean ± standard deviation, whereas categorical variables were presented as frequencies and percentages. Chi-square test was used for comparison of categorical variables and a p-value <0.05 was considered statistically significant. Results: The mean age of the study participants was 50 ± 5.6 years, while the mean body mass index was 23.8 ± 4.1 kg/m². Endometriosis constituted the most frequent indication for surgery (34%), followed by uterine myoma (28%) and abnormal uterine bleeding (24%). Hysterectomy with bilateral salpingectomy was performed in 86% of patients. The mean total hospital stay was 6 ± 1 days, whereas the average postoperative hospital stay was 3.7 ± 1.1 days. Return of bowel function occurred early, with the mean time to first flatus being 12.5 ± 3.2 hours, first defecation 20.5 ± 2.6 hours, and initiation of solid oral diet 33.9 ± 7.2 hours. Most patients (88%) experienced an uncomplicated postoperative course. Only a small proportion developed hematoma (4%), hemoperitoneum (4%), or wound infection (4%). No statistically significant association was observed between the type of surgical procedure and postoperative complications (p=0.636). These findings indicate that implementation of the ERAS protocol was associated with accelerated postoperative recovery, reduced morbidity, and shorter hospitalization while maintaining patient safety. The numerical results reported here are derived from the original study dataset. Conclusion: Implementation of the Enhanced Recovery After Surgery protocol in women undergoing total abdominal hysterectomy resulted in early postoperative recovery, rapid restoration of bowel function, reduced postoperative complications, decreased analgesic requirements, and shorter duration of hospitalization. ERAS represents a safe, practical, and effective perioperative care pathway that can significantly improve patient outcomes following abdominal hysterectomy. Wider adoption of standardized ERAS protocols in tertiary care hospitals may contribute to improved quality of surgical care, enhanced patient satisfaction, and more efficient utilization of healthcare resources.