Enhanced recovery after surgery reduces postoperative nausea and vomiting in gynecological surgery: systematic review and meta-analysis of randomized and observational studies
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 (I2 = 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.