# Paving the Way for ERAS in German Gynecologic and Gynecologic Oncology Departments: Insights into Barriers, Facilitators and Practical Strategies

## TL;DR

This study explores why Enhanced Recovery After Surgery (ERAS) is not widely adopted in German gynecology departments and finds that better education and staff support can help.

## Contribution

The study identifies specific barriers and facilitators to ERAS adoption in German gynecology and highlights the role of education and multidisciplinary support.

## Key findings

- Limited ERAS knowledge and insufficient personnel are the main barriers to implementation.
- Patient-centered benefits and interactive education are the strongest facilitators for ERAS adoption.
- Well-informed clinicians are more likely to report positive professional impacts from ERAS.

## Abstract

What are the main findings?
Limited ERAS knowledge and insufficient personnel identified as primary implementation barriers.Patient-centered benefits and interactive education emerged as the strongest facilitators.

Limited ERAS knowledge and insufficient personnel identified as primary implementation barriers.

Patient-centered benefits and interactive education emerged as the strongest facilitators.

What are the implications of the main findings?
Targeted education and multidisciplinary support can substantially improve ERAS uptake.Strengthening ERAS knowledge may enhance professional satisfaction and staff engagement.

Targeted education and multidisciplinary support can substantially improve ERAS uptake.

Strengthening ERAS knowledge may enhance professional satisfaction and staff engagement.

Background: Enhanced Recovery After Surgery (ERAS) protocols improve postoperative outcomes and promote multidisciplinary, evidence-based perioperative care. However, ERAS adoption in gynecological departments remains inconsistent, and the underlying implementation challenges are poorly understood. Objective: To identify key barriers, facilitators, and preferred implementation strategies influencing ERAS adoption in German gynecological departments, and to assess whether clinicians’ ERAS knowledge or institutional certification shapes these perceptions. Methods: We conducted a nationwide, web-based cross-sectional survey of gynecologic clinicians in Germany. The questionnaire assessed ERAS-related knowledge, current implementation status, and perceived barriers, facilitators, and strategies. Statistical analyses included equality of proportions tests, logistic regression, and internal consistency measurement. Results: A total of 116 clinicians participated; 66 provided data on barriers and 64 on facilitators and strategies. Only 37.9% reported routine ERAS use. The most frequently identified barriers were limited ERAS knowledge (40.9% “very important”) and insufficient personnel resources (40.9%). The strongest facilitators were improved patient well-being, reduced morbidity, and higher patient satisfaction (each >60% “very important”). High-impact implementation strategies included informational materials, workshops, and online training. Well-informed clinicians had significantly higher odds of reporting a positive professional impact of ERAS (OR = 9.0, p = 0.001). Conclusions: ERAS implementation in gynecological settings remains restricted by staff knowledge gaps and personnel limitations. Patient-centered benefits and interactive educational strategies serve as powerful facilitators. Enhanced staff education and multidisciplinary support structures may substantially improve ERAS uptake and contribute to greater professional satisfaction among clinicians.