Enhanced recovery after surgery reduces postoperative nausea and vomiting in gynecological surgery: systematic review and meta-analysis of randomized and observational studies
In brief
ERAS cuts postoperative nausea and vomiting risk by about half in gynecologic surgery
A meta-analysis of 18 trials involving 3,275 women found that enhanced recovery pathways halved the odds of experiencing nausea or vomiting after gynecologic operations compared with standard care. The benefit was consistent across randomized and observational studies, with low heterogeneity, suggesting that broader use of ERAS could markedly improve postoperative comfort, though optimal protocol components remain to be defined.
- Journal
- Frontiers in medicine (Q1)
- Published
- 12 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Xin Zhou, Mengyu Zhang, Ping Zheng
- PMID
- 42656745
- DOI
- 10.3389/fmed.2026.1909915
Why clinicians should know about it
- Picked for Obstetrics and Gynecology (top studies of the week, 30 August 2026): Meta‑analysis shows ERAS cuts PONV after gynecologic surgery
Abstract
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted in the perioperative management of gynecological conditions. However, the aggregate impact of ERAS on postoperative nausea and vomiting (PONV) following gynecological surgery remains incompletely characterized. OBJECTIVE: To evaluate the effectiveness of ERAS protocols in reducing PONV incidence among patients undergoing gynecological surgery. METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 and MOOSE guidelines. A comprehensive literature search was performed across Web of Science, PubMed, Embase, and ScienceDirect from the inception of the databases up to April 2026. The Cochrane Risk of Bias 2 (RoB 2) tool was used for RCTs, and the Newcastle-Ottawa Scale (NOS) was used for cohort studies. The primary outcome was PONV incidence following gynecological surgery. Pooled effect estimates were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Robustness was assessed through sensitivity analysis. Publication bias was evaluated using funnel plots, Begg's test, and Egger's test. RESULTS: Eighteen studies (11 RCTs and 7 cohort studies), encompassing 3,275 patients and conducted between 2014 and 2026, were included. Fixed-effects meta-analysis demonstrated that ERAS significantly reduced PONV incidence compared with conventional care (OR = 0.48, 95% CI = 0.40 to 0.58, P < 0.001). Statistical heterogeneity was low (I 2 = 29.8%, P = 0.114). Subgroup analysis revealed that the mean BMI was the possible source of heterogeneity (interaction P-value = 0.045). Neither influential studies nor significant publication bias were identified. CONCLUSION: Implementation of ERAS protocols significantly reduces PONV following gynecological surgery. Widespread adoption of standardized ERAS pathways is essential to optimize postoperative recovery and alleviate the burden of PONV in this patient population. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359744, identifier CRD420261359744.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.