ERAS Compliance and Postoperative Outcome in Patients Undergoing Cytoreductive Surgery (CRS) and Hyperthermic...

Background Cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which is now recognised worldwide as the standard treatment for primary and secondary peritoneal surface malignancies, is associated with significant physiological stress, morbidity, and prolonged recovery. Enhanced Recovery After Surgery (ERAS) protocols aim to optimise perioperative care and attenuate surgical stress responses. This study evaluated ERAS compliance (primary objective) and its impact on postoperative outcomes (secondary objective) in CRS-HIPEC patients at a high-volume Indian tertiary centre. Methods A prospective observational study of CRS-HIPEC patients managed using ERAS (1st July 2021- 31st December 2022) was compared with a retrospectively collected pre-ERAS cohort (1st January 2019- 30th June 2020). Compliance with 27 ERAS parameters across four perioperative phases was recorded. Postoperative complications, ICU stay, and hospital stay were compared. Multivariable linear and logistic regression analyses were performed to assess predictors of outcomes. Results Eighty-five ERAS and 78 pre-ERAS patients were analysed. Demographics, PCI score and tumour distribution were comparable. Complete adherence (100%) was achieved in 59% of ERAS parameters, while 26% had 85-94% compliance. The overall compliance to ERAS protocol per patient was 94.76% with the. highest noted for the prehabilitative and preoperative domains, with the mean rates of 99.71% and 99.33%, respectively, while the lowest compliance was in the postoperative domain, with a mean of 94.38%. ERAS implementation significantly reduced Intensive Care Unit(ICU) stay (3.01 vs. 1.15 days; p < 0.001) and hospital stay (9.67 vs. 7.52 days; p < 0.001). Overall immediate postoperative complications declined from 33.3% to 12.9% (p = 0.003), mainly due to reductions in Clavien-Dindo grade I-II complications. Major morbidity, readmission and mortality rates were similar. Regression analysis showed ERAS implementation was independently associated with reduced ICU and hospital stay, and lower early complications. Conclusion ERAS implementation in CRS-HIPEC is feasible in the Indian setting, demonstrates high protocol adherence, and significantly improves perioperative outcomes without increasing readmissions or mortality.

The online version contains supplementary material available at https://doi.org/10.1007/s13193-026-02545-3.