A prospective observational study to assess the compliance to enhanced recovery protocols among patients undergoing bone and soft tissue cancer surgeries and their postoperative outcomes

The Enhanced Recovery After Surgery (ERAS®) protocols are designed to maximize postoperative recovery and reduce complications. Despite extensive research on ERAS®, its implementation in bone and soft tissue surgeries is under investigated. The study aimed to assess the percentage compliance with individual components of the ERAS® pathway, determine the average overall compliance among patients, and compare postoperative complications across varying levels of compliance. In 300 patients with bone and soft tissue cancer surgeries from December 2021 to May 2023, we measured 20 ERAS® components for compliance including preoperative, perioperative, and postoperative items. We computed compliance percentages and postoperative results like postoperative length of stay, postoperative complications as per Clavien-Dindo (CD) class of complications, and readmission rates. The overall compliance rate with ERAS® protocols was 84.5% (81.8% in bone tumour groups and 82.2% in soft tissue groups). A significant correlation was observed between higher compliance and better outcomes. Patients with higher compliance had a shorter median hospitalstay of 7 days compared to 10 days for those with lower compliance (p < 0.001). Additionally, 70.3% of patients mobilized with limb physiotherapy within 24 h of surgery, and 98.7% received multimodal analgesia. Majority (81.7%) of the patients experienced minor complications (CD class I-II), and 5.6% experienced major complications (CD class III-V). Higher ERAS® compliance was associated with shorter hospital stays and fewer complications, suggesting its potential of better postoperative outcomes in bone and soft tissue cancer surgeries. Further studies stratifying patients by surgical complexity are needed to confirm these findings. Clinical Trial Registry Number: CTRI/2021/11/038241.