IMPACT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOL IMPLEMENTATION ON LENGTH OF HOSPITAL STAY AND POSTOPERATIVE OUTCOMES IN GENERAL SURGERY: A RETROSPECTIVE COHORT STUDY

Background: Enhanced Recovery After Surgery (ERAS) protocols are multidisciplinary, evidence-based perioperative pathways designed to reduce surgical stress, enhance functional recovery, and improve postoperative outcomes. While ERAS implementation has frequently been associated with reduced length of hospital stay (LOS), its effect may vary across healthcare settings with already optimized perioperative and discharge practices. Objective: To evaluate the association between ERAS protocol implementation and length of hospital stay among general surgery patients, and to assess its impact on postoperative complications and early recovery indicators. Methods: A retrospective cohort study was conducted at King Faisal Hospital, Makkah, Saudi Arabia, using electronic medical records from January 2022 to December 2023. A total of 938 patients who underwent general surgery procedures were included and categorized into ERAS and non-ERAS groups. Demographic characteristics, surgical and anesthetic factors, postoperative recovery indicators, and clinical outcomes were analyzed. Length of hospital stay was assessed using predefined duration categories. Comparative analyses were performed using chi-square tests and either t-tests or Mann–Whitney U tests, as appropriate. Statistical significance was set at p < .05. Results: ERAS protocols were implemented in 91.3% of patients. No statistically significant difference in length of hospital stay was observed between ERAS and non-ERAS groups (89.6% vs. 90.2% with LOS < 1 week, p = .674). In contrast, ERAS implementation was associated with a significantly lower overall rate of postoperative complications (4.8% vs. 20.7%, p < .001), particularly gastrointestinal (1.5% vs. 12.2%, p < .001) and respiratory complications (0.5% vs. 3.7%, p < .001). Patients managed with ERAS protocols demonstrated improved early recovery indicators, including earlier tolerance of oral intake and reduced postoperative nausea. ICU admission rates were low in both groups, and hospital readmission rates showed a statistically significant but clinically small absolute difference. Conclusion: ERAS protocol implementation in general surgery is associated with substantial reductions in postoperative complications and improvements in early recovery outcomes. Although no reduction in length of hospital stay was observed—likely reflecting already optimized institutional discharge pathways—these findings support the continued integration of ERAS principles to enhance perioperative care quality.