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. 2025 Mar 29;17(3):e81420.
doi: 10.7759/cureus.81420. eCollection 2025 Mar.

The Relationship Between Postoperative Outcomes of Gynecologic Patients After Receiving the Enhanced Recovery After Surgery (ERAS) Protocol Versus Narcotic Medication for Pain Management

Ovgu Barut  1 , Dynora Pierre-Louis  2 , Jose Luis Terrazas  2 , Adi Abramovici  3
Affiliations

The Relationship Between Postoperative Outcomes of Gynecologic Patients After Receiving the Enhanced Recovery After Surgery (ERAS) Protocol Versus Narcotic Medication for Pain Management

Ovgu Barut et al. Cureus. .

Abstract

This retrospective research project will assess the utilization of the Enhanced Recovery After Surgery (ERAS) protocol compared to narcotic treatment in the postoperative course of benign gynecological surgeries. We intend to study the potential relationship between the frequency of readmission rates, deep vein thrombosis (DVT), pulmonary embolism (PE), length of stay, and opioid use in the pre-discharge period in those who receive the ERAS protocol versus narcotics for pain management. The goal is also to increase the implementation of the ERAS protocol in our hospital if it is shown to be superior in this project. We hypothesize that the rate of readmission, frequency of DVT, PE, length of stay, and opioid use in the pre-discharge period will be lower in patients receiving the ERAS protocol. Female patients older than 18 years old who underwent robotic/laparoscopic/abdominal benign gynecologic surgeries in the inpatient setting between 2020 and 2023 in the HCA Florida East Division hospitals were included in this study. The analysis indicates that being in the narcotics group (incidence rate ratio (IRR) = 1.242, p = 0.001) or the ERAS + narcotics group (IRR = 1.886, p < 0.001) is associated with a significantly longer length of stay compared to the ERAS group. A grouped Charlson Index score of 1 (IRR = 1.285, p < 0.001) or 2 or higher (IRR = 2.000, p < 0.001) is also associated with a longer length of stay. Other covariates, including age, race, BMI, and smoking status, did not show statistically significant associations. The results show that being in the ERAS + narcotics group is significantly associated with increased odds of readmission (OR = 3.507, p < 0.001) compared to the ERAS group (readmission is analyzed regardless of specific diagnosis). Older age groups, specifically 45-64 years (OR = 0.574, p = 0.001) and 65 years and over (OR = 0.439, p < 0.001), are associated with lower odds of readmission compared to the 18-44 years group. Older patients may receive more comprehensive care, discharge planning, medications, and follow-ups tailored to their profile, hence returning less compared to the younger group. A grouped Charlson Index score of 1 (OR = 1.692, p = 0.019) or 2 or higher (OR = 3.086, p < 0.001) is significantly associated with increased odds of readmission. We conclude that the utilization of the ERAS protocol compared to narcotic treatment in the postoperative course of benign gynecological surgeries is superior to narcotic treatment and narcotic treatment combined with the ERAS protocol. The ERAS group was associated with shorter length of stay and decreased rates of readmission. Implementing the ERAS protocol as a standard of care is an important step shown to decrease hospital costs, improve patient outcomes, and improve hospital quality.

Keywords: eras protocol; gynecologic surgery; gynecology; minimally invasive surgery; postoperative pain.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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