Enhanced Recovery After Surgery in Hysterectomy Patients

Effectiveness of Enhanced Recovery After Surgery (ERAS) Protocols in Hysterectomy Patients. A Prospective,Randomized Controlled Clinical Trial.

This prospective randomized controlled clinical trial aims to evaluate the effectiveness of Enhanced Recovery After Surgery (ERAS) protocols in patients undergoing elective hysterectomy. ERAS is an evidence-based perioperative approach designed to reduce surgical stress, accelerate recovery, and improve clinical outcomes. Participants will be randomized to receive either ERAS-based care or conventional perioperative management. The study will assess whether ERAS implementation reduces hospital stay and improves postoperative recovery without increasing complications.

Enhanced Recovery After Surgery (ERAS) protocols are structured, multidisciplinary perioperative care pathways developed to optimize surgical outcomes by minimizing physiological stress and promoting early recovery. These protocols include preoperative counseling, shortened fasting with carbohydrate loading, opioid-sparing anesthesia, early feeding, and early mobilization.

Hysterectomy remains one of the most common gynecological procedures worldwide and is often associated with prolonged hospital stay and postoperative morbidity, particularly in resource-limited settings. While international evidence supports the benefits of ERAS in improving outcomes such as reduced length of hospital stay, improved pain control, and decreased complications, there is a need for locally generated data to validate its effectiveness in Egyptian tertiary healthcare settings.

This study will be conducted at Kasr Al-Ainy Hospital, Cairo University, and will include women undergoing elective hysterectomy for benign or early-stage malignant gynecological conditions. Participants will be randomly assigned to either the ERAS group or the conventional care group. Outcomes will be assessed during hospitalization and up to 30 days postoperatively.

Inclusion Criteria:

• Women aged 18-70 years.
• Undergoing elective total hysterectomy for benign or early stage malignant gynacological conditions .
• ASA ( American Society of Anesthesiologists ) physical status I-II.
• Able to provide informed consent.

Exclusion Criteria:

• Emergency hysterectomy
• Advanced malignant requiring extensive debulking
• Known bowel disease or previous bowel surgery ( crohn's disease , bowel obstruction )
• Significant cognitive impairment or psychiatric illness
• Inability to follow ERAS protocol (e.g., cognitive impairment)
• Refusal to participate