The effect of enhanced recovery after surgery in laparoscopic sacrocolpopexy: a randomized controlled trial.

BACKGROUND

The enhanced recovery after surgery (ERAS) protocol has been demonstrated to improve patient outcomes; however, its efficacy has not been prospectively evaluated in randomized controlled trials (RCTs) for patients undergoing laparoscopic sacrocolpopexy (LSC). This study aimed to develop a multidisciplinary ERAS protocol specifically for LSC and to systematically evaluate its clinical efficacy and benefits following implementation.

MATERIALS AND

METHODS

In this prospective RCT conducted between September 2023 and February 2024, 80 patients undergoing LSC were randomized to either ERAS protocol (Group E) or conventional perioperative care (Group C). Primary outcomes included postoperative length of stay (LOS) and hospitalization costs, with secondary outcomes assessing recovery parameters, complication rates, pain scores, vital signs, and laboratory markers.

RESULTS

Implementation of the ERAS protocol significantly reduced median postoperative LOS [77.00 (69.00-87.00) h vs. 46.50 (40.00-50.00) h; median difference: 31.00 h, 95% CI: 26.00-36.00; P < 0.001]. The ERAS group showed statistically significant improvements in multiple recovery metrics: earlier urinary catheter removal (median reduction 12 hours), quicker resumption of oral intake (18 hours), faster return of bowel function (8 hours), and earlier ambulation (4 hours) (all P < 0.001). Group E exhibited significantly improved 7-day QoR-15 scores (P = 0.002), reduced pain scores, decreased opioid use, lower postoperative white blood cell counts, and fewer episodes of postoperative nausea and vomiting. The 30-day readmission and emergency department visit rates in both group were zero.

CONCLUSION

This RCT establishes that implementation of an ERAS protocol for LSC significantly enhances postoperative recovery, reduces pain and complications, decreases opioid use while attenuating surgical stress responses. The 40.26% reduction in (LOS) meets the minimum clinically important difference threshold, indicating a clinically meaningful improvement. Additionally, the 30-day readmission and ED visit rates remained zero, further confirming the safety of the ERAS protocol in low-risk women.