To systematically evaluate the clinical application effect of enhanced recovery after surgery (ERAS) protocols in patients undergoing bariatric and metabolic surgery.

A systematic search was performed across multiple Chinese and English-language databases, including the Joanna Briggs Institute (JBI) Database of Evidence-Based Healthcare, Embase, the Cochrane Library, Web of Science, PubMed, CNKI, CINAHL, Wanfang Data, VIP Database, and the Chinese Biomedical Literature Database. The search period spanned from the inception of each database through December 25, 2024. Two investigators, both rigorously trained in systematic review methodologies, independently conducted the screening, quality assessment, and data extraction processes. Meta-analyses were conducted using RevMan version 5.3. For dichotomous variables, odds ratios (OR) with 95% confidence intervals (CI) were calculated, whereas continuous variables were summarized using mean differences (MD) with corresponding 95%CI.

A total of 16 studies involving 3,576 patients were included. Meta-analysis results demonstrated that, compared with conventional perioperative management, ERAS protocols significantly reduced length of hospital stay [MD= -1.40, 95%CI (-1.82, -0.99), P<0.00001], decreased the incidence of postoperative nausea and vomiting (PONV) [OR= 0.44, 95%CI (0.21, 0.92), P= 0.03], and lowered hospitalization costs [MD= -8061.24, 95%CI (-12925.10, -3197.38), P= 0.001]. No statistically significant differences were observed between ERAS and conventional care in terms of overall postoperative complications [OR= 1.00, 95%CI (0.75, 1.32), P= 0.98], 30-day readmission rate [OR= 0.87, 95%CI (0.60, 1.26), P= 0.46], reoperation rate [OR= 0.73, 95%CI (0.34, 1.59), P= 0.43], or postoperative analgesic use [OR= 0.47, 95%CI (0.21, 1.04), P= 0.06].

ERAS protocols can effectively optimize perioperative management for bariatric and metabolic surgery patients by shortening hospital stay, reducing PONV incidence, and lowering healthcare costs without increasing the risk of adverse postoperative events. The clinical benefits of ERAS are not derived from a single intervention but from the synergistic effects of multiple core components. Given the heterogeneity and methodological limitations of existing studies, future research should expand sample sizes, include more high-quality trials, and conduct rigorously designed randomized controlled trials to clarify the independent contributions and synergistic effects of individual ERAS elements, thereby further validating the clinical effectiveness of ERAS in bariatric and metabolic surgery.