Abstract:
Background: The Enhanced Recovery after Surgery protocol is a systematic, evidence-based
method to optimizing perioperative care, improving patient outcomes, and promoting recovery.
Despite its established benefits, many healthcare settings, particularly those with limited resources,
struggle to fully adhere to the protocol. In addition there is lack of evidence based information on
the Knowledge, attitude, practice and factors associated with the practice of the enhanced recovery
after surgery protocol among health care professionals in public hospitals in Harar, Eastern
Ethiopia.
OBJECTIVE: To assess knowledge, attitude, practice and factors associated with the practice of
enhanced recovery after surgery protocol among health care professionals in public hospitals in
Harar, Eastern Ethiopia, from September 1 to October 30, 2025.
Methods: An institution-based cross-sectional study was conducted among 270 healthcare
professionals who are working in public hospitals of Harar. Data were collected using Kobo
Toolbox and analyzed with Stata version 17. Bivariable and multivariable logistic regression
analyses were performed, and variables with p < 0.05 in the multivariable model were considered
independent predictors of consistent practice.
Results: Among the participants, 21% had adequate knowledge and 19% exhibited a positive
attitude toward the Enhanced Recovery after Surgery (ERAS) protocol, while only 36%
demonstrated consistent practice across all ERAS components. Working in referral or teaching
hospitals (AOR = 1.89, 95% CI: 1.12–3.19) and having a positive attitude (AOR = 2.11, 95% CI:
1.11–4.00) were associated with higher odds of consistent practice, whereas participants with more
than five years of experience had lower odds (AOR = 0.43, 95% CI: 0.24–0.79).
Conclusion: Knowledge, attitude, and consistent practice of the ERAS protocol were low.
Working in referral or teaching hospitals and having a positive attitude were associated with better
practice, whereas longer professional experience was linked to lower adherence, underscoring the
need for targeted interventions to improve ERAS implementation.
