Asian Journal of Research in Surgery

Background/Objectives: Enhanced recovery after surgery (ERAS) is a comprehensive perioperative care concept that focuses on evidence-based multidisciplinary, standardized, and patient-centered approach with the aim of enhancing the quality of postoperative recovery. An audit of a hospital’s surgical service ERAS practices in the absence of a structured programme, helps identify where it is lacking and how to be improved while also being incorporated into the system.

Methods: The study employed a mixed methods approach, involving a dual-cycle closed-loop audit.

First Cycle: There was a retrospective audit of 150 patients chosen by convenient sampling who underwent elective abdominal surgery at Mary Immaculate Specialist Hospital in Benin between 15th of October 2023 to 15th of October 2024. Every component of ERAS was carefully noted in patient’s records and adherence to 16 (pre-operative, intra-operative and post-operative) components from the ERAS guidelines were analyzed.

Second Cycle: The re-audit involved convenient sampling of 65 surgical cases and using the same eligibility criteria as in the first cycle but with prospective data collection and was conducted between November 2024 and May 2025.

Results: A total 215 surgical cases were reviewed; comprising 150 in the first cycle and 65 in the second cycle and all pertained to elective abdominal surgeries. The demography consists of 125 females, 25 males, and with a mean age of 36.75 years (14.75) (range of 11 to 80 years), while in the second cycle, twenty (20) adult males, forty five (45) adult females, with a mean age of 36.7 (12.56). Elective abdominal surgeries included were cesarean section, total abdominal hysterectomy, myomectomy, appendectomy and explorative laparotomy. Overall adherence to items required in the ERAS protocol was 47.6% at our hospital even before the ERAS program was implemented. After implementation, overall adherence was increased to 86.8%. In the first cycle, post-operative stay of 66% of the patients was > 48hrs, however this improved in the second cycle as post-operative stay of 73.3% of patients was < 48hrs.

Conclusion: The surgical team’s compliance to ERAS in the absence of an established programme or checklist revealed inconsistencies in adherence and the need for development of protocols and formation of a dedicated team. These indeed brought about a positive change in our hospital as re-audit showed improved compliance to ERAS and reduction in post-op hospital stay.