Enhanced Recovery Protocols in Deep Endometriosis Surgery

ERAS protocols shorten hospital stays without increasing complications in DIE surgery.

Key Points

Highlights:

• Enhanced Recovery After Surgery (ERAS) protocols reduce hospital stays in deep infiltrating endometriosis (DIE) surgery without increasing complications or readmissions.
• These findings support incorporating ERAS into perioperative management of DIE.

Importance:

• This meta-analysis highlights ERAS as a promising strategy to optimize recovery and resource utilization in complex DIE surgeries.

What’s done here:

• A systematic review and meta-analysis examined the effectiveness of ERAS protocols versus standard care in DIE surgery, pooling data from four comparative studies of total 1,662 patients.
• Outcomes assessed included hospital stay duration, readmission rates, and postoperative complications.
• Quality assessments used validated bias tools. 

Key results:

• ERAS protocols significantly reduced the average hospital stay length after DIE surgery.
• ERAS protocols were not associated with an increase in the rate of readmission. 
• The complication rates were not different between ERAS protocols and conventional care.

Limitations:

• Small number of included studies and variability in surgical techniques and ERAS components.
• Predominantly retrospective data increases potential for selection bias.
• Lack of reporting on adherence to specific ERAS elements limits interpretation of protocol fidelity.

From the Editor-in-Chief – EndoNews

"This meta-analysis underscores the growing potential of ERAS protocols to transform perioperative care in deep infiltrating endometriosis surgery. By significantly reducing hospital stays without increasing complications or readmissions, ERAS offers a path toward faster recovery and improved patient experience in these complex procedures.

Yet, the findings also highlight the current evidence gaps. With only four studies included, most retrospective and heterogeneous in design, the need for robust, large-scale randomized trials is clear. As the field moves toward precision and multidisciplinary care in endometriosis management, ERAS deserves serious consideration—not as an adjunct, but as a standard of care tailored to this unique patient population."

Lay Summary

Enhanced Recovery After Surgery (ERAS) protocols may offer significant benefits for patients undergoing complex procedures for deep infiltrating endometriosis  (DIE), according to a meta-analysis recently published in Facts, Views & Vision in ObGyn. The study found that ERAS programs reduced hospital stays without increasing postoperative complications or readmission rates.

Led by Dr. Athanasios Protopapas from the National and Kapodistrian University of Athens, the research team analyzed data from four comparative studies involving 1,662 patients. They reported that ERAS implementation shortened the average hospital stay by nearly three days. Importantly, this reduction did not come at the cost of patient safety, as complication rates, including minor and major events; and readmissions remained comparable to conventional care.

ERAS protocols are comprehensive perioperative care pathways designed to support faster recovery. They include preoperative education, nutritional optimization, pain management strategies that minimize opioid use, and early postoperative mobilization. While widely adopted in other surgical fields, their use in DIE management remains limited.

“However,  the authors emphasize that although these findings are promising, larger randomized trials are needed to confirm ERAS’ role in improving outcomes for patients undergoing major endometriosis surgeries.

ERAS protocols are care pathways used during surgery to achieve early recovery after surgery. They include counselling before surgery, optimization of nutrition, standardized analgesic and anesthetic regimens, and early mobilization.

Research Source: https://pubmed.ncbi.nlm.nih.gov/40297931/