Enhanced recovery in gynecologic surgery: institutional challenges and implementation framework

Enhanced recovery after surgery (ERAS) protocols are evidence-based peri-operative care pathways that aim to reduce surgical stress, enhance patient recovery, and improve clinical outcomes. Despite well-documented benefits, real-world implementation remains inconsistent, with adherence rates varying widely across institutions and regions. This review offers practical insights, addressing core challenges in ERAS protocol compliance evaluation, including patient adherence, provider engagement, workflow integration, and documentation. We aim to provide a practical framework for other institutions seeking to adopt ERAS, offering actionable strategies to overcome common barriers and achieve long-term success with data-driven quality improvement. Peri-operative measures are outlined, highlighting implementation challenges and potential solutions. Successful ERAS implementation extends beyond protocol design. It requires sustained institutional support, clear and consistent communication, ongoing education, and pragmatic adaptation to the local infrastructure.