Enhanced recovery after surgery protocols in resource-constrained settings: Feasibility, impact and…

Cohort studyJournal of perioperative practice· Aug 2026

Enhanced recovery after surgery protocols in resource-constrained settings: Feasibility, impact and cost-neutral prioritisation from a 15-month prospective observational study.

Rudraksh Kesharwani, Arundati Ramdas Raikar, Saurabh Raj … Raj Vaghani

Surgical Outcomes & RecoveryCohort studyClinical practiceQ3IF 0.7

Nearly half of patients had a postoperative complication after gastrointestinal surgery

Enhanced recovery after surgery protocols in resource-constrained settings: Feasibility, impact and cost-neutral prioritisation from a 15-month prospective observational study.

Rudraksh Kesharwani … Raj Vaghani

Journal of perioperative practice · Aug 2026 · Q3 in Surgery

Background

Enhanced recovery after surgery (enhanced recovery after surgery) protocols improve postoperative outcomes in high-income settings, but evidence supporting their implementation in resource-constrained hospitals remains limited.

Purpose

To evaluate perioperative practices and postoperative complications following common gastrointestinal surgery and identify feasible, cost-neutral enhanced recovery after surgery components for prioritised implementation in a resource-constrained setting.

Methods

A 15-month prospective observational study was conducted in a semi-urban government teaching hospital in India.

n = 522 patients

Results

nearly half of patients had a complication after surgery

Surgical site infectio

24.3%

Postoperative ileus

19.7%

Sepsis

16%

Pneumonia

13.4%

More results

The most frequent complications were surgical site infection (24.3%), postoperative ileus (19.7%), sepsis (16.0%), pneumonia (13.4%), and catheter-associated urinary tract infection (9.8%).

Mapping these findings to enhanced recovery after surgery principles identified a limited set of high-impact, cost-neutral interventions targeting the most common complications.

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Conclusion · 1 of 2

Selective implementation of prioritised, cost-neutral enhanced recovery after surgery components offers a pragmatic strategy to reduce postoperative morbidity and improve surgical outcomes in resource-constrained hospitals without increasing healthcare expenditure.

Conclusion · 2 of 2

Prospective interventional studies are needed to validate this approach.

Enhanced recovery after surgery protocols in resource-constrained settings: Feasibility, impact and cost-neutral prioritisation from a 15-month prospective observational study.

Enhanced recovery after surgery protocols in resource-constrained settings: Feasibility, impact and cost-neutral prioritisation from a 15-month prospective observational study.

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