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Evaluation of the recovery speed and safety of fastest recovery after surgery vs enhanced recovery after surgery in patients undergoing gastrointestinal tumor surgery
De-Hua Zhou, Rui Li, Ding-Tao Xu, Shu Zhang, Nan Zhang, Yi-Ping Ni, Han-Rong Liu, Zhuo Chen, Zhen-Xing Huang, Cheng Chang, Zhi-Hao Shi, Yu-Xiang Xie, Shao-Hua Zhang, Ru-Hong Shi, Ting-Ting Ge, Hui-Ming Zhou, Min-Jun Zhou, Qi-Zhi Liu, Xiao-Huang Tu
De-Hua Zhou, Rui Li, Nan Zhang, Yi-Ping Ni, Han-Rong Liu, Zhuo Chen, Zhen-Xing Huang, Cheng Chang, Zhi-Hao Shi, Yu-Xiang Xie, Shao-Hua Zhang, Qi-Zhi Liu, Xiao-Huang Tu, Department of Gastrointestinal Surgery, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
Ding-Tao Xu, Department of Anesthesia and Perioperative Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
Shu Zhang, Department of Surgery, Fudan University Shanghai Cancer Center, Shanghai 200000, China
Ru-Hong Shi, Ting-Ting Ge, Hui-Ming Zhou, Min-Jun Zhou, Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
Co-first authors: De-Hua Zhou and Rui Li.
Co-corresponding authors: Qi-Zhi Liu and Xiao-Huang Tu.
Author contributions: Zhou DH and Li R contributed equally to this work as co-first authors, with the former author being primarily responsible for data curation, formal analysis, and original drafting, and the latter author coordinating methodology development, investigation, and manuscript revision; Xu DT contributed to anesthesia and perioperative management; Zhang S and Zhang N contributed to statistical analysis; Ni YP, Liu HR and Chen Z contributed to patient follow-up and outcome assessment; Huang ZX, Chang C, and Shi ZH contributed to inflammatory marker analysis and data interpretation; Xie YX and Zhang SH contributed to nursing and protocol execution; Shi RH, Ge TT, Zhou HM, and Zhou MJ contributed to the collective performance of preoperative evaluation, dietary recovery, and satisfaction surveys; Liu QZ and Tu XH served as co-corresponding authors and jointly supervised the study design and funding acquisition, along with providing critical intellectual revisions.
Supported by Hongkou District Health Commission of Shanghai Municipality, No. Hongwei2303-10; the Key Project of the Discipline Promotion Program at Shanghai Fourth People’s Hospital, No. SY-XKZT-2023-2001; the Nursing Special Project of the Discipline Promotion Program at Shanghai Fourth People’s Hospital, No. SY-XKZT-2025-2009; and the Talent Promotion Program at Shanghai Fourth People’s Hospital, No. SY-XKZT-2024-3002.
Institutional review board statement: This retrospective study was conducted in accordance with the ethical standards of the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Fourth People’s Hospital (Approval No. SYLL2023013).
Informed consent statement: This study is a retrospective cohort study. All data were obtained from the hospital’s electronic medical record system and underwent rigorous anonymization procedures, with no new collection of human tissues or blood samples. Given the retrospective design and the use of fully anonymized data, the risk to participants was minimal. Furthermore, as the research could not be practically conducted if individual informed consent were required, the ethics committee granted a formal waiver of informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets are available from the corresponding author upon reasonable request.
Corresponding author: Xiao-Huang Tu, MD, PhD, Chief Physician, Professor, Department of Gastrointestinal Surgery, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, No. 1279 Sanmen Road, Hongkou District, Shanghai 200434, China.
tuxiaohuang@126.com
Received: September 26, 2025
Revised: November 19, 2025
Accepted: January 16, 2026
Published online: March 27, 2026
Processing time: 183 Days and 0.1 Hours
BACKGROUND
Although enhanced recovery after surgery (ERAS) protocols have significantly improved perioperative outcomes, opportunities for further optimization remain. The fastest recovery after surgery (FRAS) protocol was developed to address these gaps by integrating intensified multimodal interventions aimed at achieving ultrarapid recovery.
AIM
To evaluate the efficacy and safety of the FRAS protocol compared with those of conventional ERAS in patients who underwent elective gastrointestinal tumor surgery, with a focus on recovery speed, postoperative complications, patient-reported outcomes, and economic efficiency.
METHODS
A retrospective cohort study involving 307 patients who underwent surgery between August 2021 and May 2025 was conducted. The FRAS group (n = 113) received an optimized protocol featuring ultra-early oral feeding (initiated at 1-2 hours after surgery), strict fluid restriction (< 500 mL/day), and early drain removal. The ERAS group (n = 194) received standard ERAS care. The primary outcomes included postoperative hospital stay and 30-day complication rates. Secondary outcomes included functional recovery metrics, inflammatory markers, quality of life, and patient satisfaction.
RESULTS
The FRAS group demonstrated a significantly shorter median postoperative hospital stay (22.4 hours vs 100.4 hours, P < 0.001) without exhibiting increased complication rates (4.42% vs 2.58%, P = 0.507). FRAS patients experienced earlier ambulation (4.23 hours vs 18.05 hours, P < 0.001), earlier oral intake (2.61 hours vs 11.88 hours, P < 0.001), and lower pain scores (4.85 vs 5.31, P = 0.007). The quality of life and satisfaction scores were significantly higher in the FRAS group at early postoperative time points (P < 0.05). No significant differences were observed in inflammatory marker trajectories or long-term quality of life.
CONCLUSION
Compared with ERAS, the FRAS protocol significantly accelerates postoperative recovery while maintaining safety and improving early patient-reported outcomes. It represents a safe, efficient, and patient-centered advancement in perioperative care. Future studies should validate these findings in broader populations and explore individualized FRAS strategies for high-risk patients.
Core Tip: This study introduces fastest recovery after surgery as an optimized protocol building upon enhanced recovery after surgery. In patients who underwent gastrointestinal tumor surgery, fastest recovery after surgery achieved a remarkably short median postoperative stay of approximately 22.4 hours without increasing complication rates; moreover, it also significantly improved early quality of life and patient satisfaction. This effect represents a significant advancement in perioperative care, thus demonstrating that further acceleration of recovery beyond traditional enhanced recovery after surgery is both feasible and safe in carefully selected patients.
