Abstract

Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal care pathways designed to accelerate postoperative recovery and reduce complications. While their benefits for in-hospital outcomes like length of stay (LOS) are well-established, their impact on reducing hospital readmissions, a critical quality metric, remains variable and less clearly defined across different surgical specialties. This systematic review aimed to synthesize the existing evidence on the effectiveness of ERAS protocols in reducing hospital readmission rates, to identify the key protective elements within these protocols, and to explore the factors that influence this relationship. A systematic literature search was conducted from inception to May 2024. Studies investigating the impact of ERAS on 30- or 90-day readmission rates in adult elective surgery were included. Eleven studies comprising over 36,000 patients were included. ERAS consistently reduced LOS without increasing readmission risk. However, its direct impact on readmission rates was highly variable. Significant reductions were reported in some studies (e.g., abdominal and spinal surgery), while others (e.g., pancreaticoduodenectomy and radical cystectomy) showed no change despite ERAS implementation. The critical factor for success was not merely having an ERAS program but achieving high adherence to its core elements, particularly early mobilization and multimodal opioid-sparing analgesia. Readmission causes were procedure-specific (e.g., pancreatic fistula, anastomotic leak), indicating that ERAS mitigates but does not eliminate inherent surgical risks. The findings highlight the need for complementary post-discharge strategies. For high-risk procedures, reducing readmissions requires integrating ERAS with procedure-specific strategies and robust post-discharge care models to support the entire recovery journey.

Key words: Enhanced recovery after surgery, hospital readmission, postoperative complications, length of stay, perioperative care, systematic review