Enhanced Recovery After Surgery (Eras) Compliance and Postoperative Outcomes

Background: Enhanced Recovery After Surgery (ERAS) protocols are evidence-based, multimodal perioperative carepathways designed to attenuate the surgical stress response and expedite recovery. While their efficacy is well-documentedin Western healthcare settings, data on compliance and its direct impact on outcomes in non-metropolitan Indian hospitalsremain limited. This study aimed to evaluate the degree of ERAS protocol compliance and its association with postoperativeoutcomes at Clearmedi Paridhi Hospital, Gwalior. Materials and Methods: This prospective, observational study wasconducted from January 2025 to December 2025. A total of 80 adult patients undergoing elective major abdominal surgerywere enrolled. The primary exposure was compliance with a standardized, locally adapted ERAS protocol consisting of 18core elements. Patients were categorized into high-compliance (≥80% adherence) and low-compliance (<80% adherence)groups. The primary outcome was the length of hospital stay (LOS). Secondary outcomes included the incidence ofpostoperative complications (graded by the Clavien-Dindo classification), 30-day readmission rates, and time to return ofbowel function. Results: The overall median compliance with the ERAS protocol was 77.8% (IQR 66.7-88.9). Fifty-fourpatients (67.5%) achieved high compliance. The high-compliance group demonstrated a significantly shorter median LOS(4.5 days vs. 7.0 days, p<0.001) and a faster return of bowel function (time to first flatus: 30 hours vs. 48 hours, p<0.001).The overall postoperative complication rate was significantly lower in the high-compliance group (16.7% vs. 42.3%,p=0.014). There was no statistically significant difference in 30-day readmission rates between the groups (p=0.64).Conclusion: High compliance with an ERAS protocol in a non-metropolitan Indian hospital setting was significantlyassociated with improved postoperative outcomes, including a shorter length of hospital stay, faster gastrointestinal recovery,and a reduction in postoperative complications. These findings underscore the importance of systematic implementation andadherence to ERAS principles to enhance surgical care quality beyond tertiary academic centers.