Introduction Enhanced Recovery After Surgery (ERAS) has significantly reduced complication rates and hospital stay in high income countries.There is a lack of perioperative multi-disciplinary teams, adherence to care guidelines and robust outcomes data in low-and middle- income countries (LMIC). The aim of this prospective cross sectional study was to determine baseline outcomes data, and compliance with guidelines prior to implementation of ERAS in Gynaecologic Oncology at a tertiary hospital in South Africa.

Methods Verbal consent to collect data was obtained from 50 patients, 18 years, and older undergoing elective gynaecological oncology surgery. Anonymised data was entered into the EIAS database by the ERAS Care coordinator. Data was collected on socio-demographic and patient characteristics as well as compliance to the ERAS guidelines in the preoperative, intraoperative, and postoperative period. Outcomes data on length of stay, readmission rates and 30-day follow-up were measured. Ethical approval for this study was obtained from the University of Cape Town Health Research Ethics Committee (HREC ref 068/2022).

Results Among the 50 patients, the overall compliance with ERAS guidelines was 43.9%. ERAS compliance was16.9% pre-admission; 78.1% pre-operative , 94.2% intra-operatively and 16.9% post-operatively. The average length of stay was 5 days, readmission rate was 4.3% and 30-day complication rate was 21.3%.

Conclusion/Implications Compliance with ERAS guidelines in gynaecologic oncology at our LMIC hospital remains low despite proven benefit of these interventions. This deficit is most pronounced in our pre-admission and post-operative periods. Formal implementation of ERAS will lead to improvement in patient outcomes in LMIC.