ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOLS IN ABDOMINAL SURGERY: EFFICACY, SAFETY AND CLINICAL OUTCOMES — AN INTEGRATIVE REVIEW

Abstract

Enhanced Recovery After Surgery (ERAS) protocols represent a multimodal and multidisciplinary approach designed to attenuate the neuroendocrine stress response and optimize perioperative care across three phases: preoperative, intraoperative, and postoperative. This integrative review aimed to analyze the available scientific evidence on the efficacy and safety of ERAS protocols in elective and emergency abdominal surgery, with emphasis on length of hospital stay, postoperative complications, opioid consumption, and readmission rates. A systematic search was conducted in PubMed/MEDLINE, SciELO, and LILACS with a strict timeframe of January 2020 to March 2026. Twenty-four studies met inclusion criteria, encompassing randomized controlled trials, systematic reviews with meta-analysis, cohort studies, and scoping reviews. Results consistently demonstrated significant reductions in hospital length of stay (ranging from −0.89 to −4.27 days depending on surgery type), lower rates of postoperative complications and surgical site infections, earlier return to oral feeding and bowel function, and decreased opioid use. Higher protocol adherence rates consistently correlated with superior clinical outcomes. ERAS protocols are concluded to be safe, effective, and cost-effective in abdominal surgery, with increasingly favorable evidence in emergency settings and resource-limited environments.