Theimpact of obesity on perioperative care: Integrating ERAS protocols for improved surgical outcomes

Abstract

Obesity represents a global health crisis, affecting over 650 million adults worldwide and markedly influencing surgical outcomes, particularly in the context of gynecologic oncology. It serves as a considerable risk factor for perioperative complications, impacting metabolic, respiratory, immune, and cardiovascular functions. Patients with obesity undergoing surgical procedures in gynecologic oncology exhibit higher incidences of wound infections, thromboembolic events, respiratory failure, and extended hospital stays. The Enhanced Recovery After Surgery (ERAS) protocol has emerged as a robust perioperative strategy to mitigate these risks and enhance surgical outcomes.

Obesity leads to significant alterations in body composition, including increased adipose tissue, causing chronic inflammation and insulin resistance, which elevate the risk of wound infections and delayed healing. Respiratory complications are exacerbated by reduced lung compliance and obstructive sleep apnea, while cardiovascular strain and thromboembolism risks are heightened by systemic inflammation and coagulation imbalances. Immune dysregulation further impairs recovery by compromising wound healing and increasing susceptibility to infection. ERAS protocols counteract these challenges through multimodal strategies, including prehabilitation, carbohydrate loading, immunonutrition, glycemic control, respiratory optimization, and enhanced mobilization. Implementing ERAS protocols has been shown to reduce postoperative morbidity by 32 %, to decrease the duration of hospital stay, to reduce the readmission rate by 20 % and to enhance overall recovery.

Integrating ERAS protocols into perioperative care for obese patients is essential for minimizing complications and enhancing recovery. A multidisciplinary, individualized approach that includes metabolic optimization, respiratory management, and thromboprophylaxis is crucial in this high-risk population. Future research should focus on refining ERAS protocols for obesity, exploring personalized nutrition strategies, and investigating long-term surgical outcomes.