Outcomes of Enhanced Recovery after Surgery in Cesarean Deliveries: A Retrospective Cohort Study from Saudi Arabia

Background: Enhanced Recovery After Surgery (ERAS) protocols have gained global recognition for improving surgical outcomes, including in cesarean section (CS) deliveries. However, evidence regarding their implementation and impact within the Saudi Arabian context remains limited. Objectives: This study aimed to evaluate the safety profile and effectiveness of ERAS protocols compared to traditional care in CS deliveries at a tertiary care center in Saudi Arabia. Methodology: A matched retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. Women who underwent CS and received ERAS-based perioperative management between January 2020 and October 2021 were compared with those who received traditional care between October 2018 and January 2019. The primary outcome was postoperative complications; other outcomes included 30-day readmission rates, total hospital length of stay (LOS), and postoperative LOS. Results: A total of 516 women were included (258 in each group). The ERAS group demonstrated significantly shorter median total hospital LOS (2 vs. 5 days; P < 0.001) and postoperative LOS (40.5 vs. 83.5 hours; P < 0.001). Postoperative complications occurred in 8% of the total cohort, with significantly fewer complications in the ERAS group (3.1% vs. 12.8%; P < 0.001). The 30-day readmission rate was also significantly lower in the ERAS group (0.8% vs. 9.3%; P < 0.001). Conclusion: ERAS protocols for CS deliveries were found to be safe, effective, and feasible in a tertiary Saudi setting. Their implementation resulted in shorter hospital stays, reduced complications, and lower readmission rates, supporting broader adoption across similar healthcare contexts.