Clinical outcomes and recovery impact of implementing enhanced recovery after surgery (ERAS) pathway in elderly patients with gynecological malignant tumors

Perioperative management is critical for optimizing recovery outcomes in elderly patients with gynecological malignant tumors, a demographic often facing significant health challenges. The Enhanced Recovery After Surgery (ERAS) pathway has been proposed as a multifaceted approach designed to enhance recovery and minimize complications during the perioperative phase, particularly in vulnerable populations such as the elderly. Patients who underwent traditional perioperative management at the affiliated hospital of Chengde Medical University between January 2011 and December 2018 were selected as the conventional group. Patients who underwent ERAS perioperative management between January 2019 and July 2025 were selected as the ERAS group. Postoperative recovery and complications were then compared between the groups. The ERAS and control groups involved 149 and 90 patients, respectively. Patient characteristics were not significantly different between the 2 groups ( P  > .05). However, the ERAS group showed a lower volume of intraoperative fluid rehydration and a shorter time to first postoperative flatus, time to first defecation, duration of postoperative hospitalization, and interval time between surgery and the first postoperative chemotherapy session. The Visual Analogue Scale score at 24 hours postoperatively was also significantly lower in the ERAS group ( P  < .05). Meanwhile, there was no significant between-group difference in the incidence of postoperative complications and the 30-day readmission rate (all P  > .05). Use of the ERAS pathway during the perioperative period does not increase the occurrence of postoperative complications and can accelerate recovery, shorten the postoperative hospitalization duration, and help with earlier initiation of postoperative chemotherapy in elderly patients with gynecological malignant tumors.