Enhanced Recovery after Surgery in Open Aortic Surgery: Experience, Evidence, and Evolving Practice at a Tertiary Care Center

Background: Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted across various surgical specialties to optimize perioperative care, improve patient outcomes, and reduce hospital length of stay (LOS). However, their implementation in open aortic surgery remains limited due to the complexity and high-risk nature of these procedures. Objective: This study evaluates the implementation, outcomes, and evolving protocols of ERAS in open aortic surgeries at a tertiary care center, highlighting our institutional experience. Methods: A randomized controlled study was conducted on patients undergoing open aortic procedures from January 2024 to June 2025. Outcomes assessed included mean hospital LOS, postoperative pain, postoperative opioid consumption, mean time to first bowel movement, and mean time to return to liquid and regular diet. Results: A total of 30 patients were included – 15 in each group. Postoperative pain scores were similar between the groups at 12 and 24 h, but there was a statistically significant reduction in pain scores in the ERAS protocol group at 36 and 48 h ( P < 0.05). A statistically significant reduction was also observed in the time taken for dietary advancement in the ERAS group ( P < 0.05). These patients also experienced earlier bowel movement. Time to transition from IV to oral analgesics was observed to have exceeded than 72 h in both groups. Patients in the ERAS protocol group had a reduction in mean hospital LOS, although this was not statistically significant. Challenges in implementation included longer surgery duration as it is an academic center, extubation delay, adherence to early mobilization, and feeding goals. Patient-specific limitations such as chronic pain and baseline functional impairment also posed challenges to full protocol adherence. Conclusion: ERAS protocols can be safely and effectively applied to open aortic surgery with demonstrable benefits in pain control and gastrointestinal recovery. Continued refinement, multidisciplinary collaboration, and patient-specific tailoring are critical for sustained success.