Long-term Follow-up of Bio-signals and Quality of Recovery Following Implementation of ERAS Based on the Mobile Application

• Enhanced Recovery After Surgery (Procedure), also known as ERAS: 1. Before surgery * Sips of water until 6 AM on the day of surgery, followed by a 200 mL carbohydrate drink * Pre-emptive oral analgesics (celecoxib 200mg 1 cap + acetaminophen 650mg 2 tab) 2. During surgery * Total intravenous anesthesia * Local anesthetic infiltration at the laparoscopic port site for post-operative pain control 3. After surgery * Sips of water and a Foley catheter removal on ward arrival * Soft meal 4 hours after surgery * General diet 8 hours after surgery
• Usual Care (Procedure): 1. Before surgery * Midnight NPO * No pre-emptive analgesics 2. During surgery \- Balanced anesthesia 3. After surgery * Sips of water 8 hours after arrival in the ward * Foley catheter removal one day after surgery * Soft meal after gas out * General diet after one soft meal

Primary outcomes

• Quality of Recovery-15, Korean version (QoR-15K) [24 hours postoperatively]: This patient-reported outcome measure consists of 15 items. Each item is rated on an 11-point Likert scale (0-10), yielding a total score ranging from 0 (very poor recovery) to 150 (excellent recovery). Higher scores indicate a better postoperative recovery.
• Quality of Recovery-15, Korean version (QoR-15K) [one week after hospital discharge]: This patient-reported outcome measure consists of 15 items. Each item is rated on an 11-point Likert scale (0-10), yielding a total score ranging from 0 (very poor recovery) to 150 (excellent recovery). Higher scores indicate a better postoperative recovery.
• Quality of Recovery-15, Korean version (QoR-15K) [one month after hospital discharge]: This patient-reported outcome measure consists of 15 items. Each item is rated on an 11-point Likert scale (0-10), yielding a total score ranging from 0 (very poor recovery) to 150 (excellent recovery). Higher scores indicate a better postoperative recovery.
• The World Health Organization Disability Assessment Schedule, Short Form (WHO-DAS) [24 hours postoperatively]: The 12-item self-administered version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) assesses disability and functioning over the previous 30 days. Each item is rated on a 5-point scale, with higher scores indicating greater disability and poorer functioning.
• The World Health Organization Disability Assessment Schedule, Short Form (WHO-DAS) [one week after hospital discharge]: The 12-item self-administered version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) assesses disability and functioning over the previous 30 days. Each item is rated on a 5-point scale, with higher scores indicating greater disability and poorer functioning.
• The World Health Organization Disability Assessment Schedule, Short Form (WHO-DAS) [one month after hospital discharge]: The 12-item self-administered version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) assesses disability and functioning over the previous 30 days. Each item is rated on a 5-point scale, with higher scores indicating greater disability and poorer functioning.
• EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) [24 hours postoperatively]: The EQ-5D-5L assesses health-related quality of life across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain is rated on a 5-level scale, where higher levels indicate more severe problems. The questionnaire also includes the EQ visual analogue scale (EQ VAS) for self-rated health.
• EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) [one week after hospital discharge]: The EQ-5D-5L assesses health-related quality of life across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain is rated on a 5-level scale, where higher levels indicate more severe problems. The questionnaire also includes the EQ visual analogue scale (EQ VAS) for self-rated health.
• EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) [one month after hospital discharge]: The EQ-5D-5L assesses health-related quality of life across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain is rated on a 5-level scale, where higher levels indicate more severe problems. The questionnaire also includes the EQ visual analogue scale (EQ VAS) for self-rated health.

Secondary outcomes

• Pain (Visual analogue scale) [24 hours postoperatively]: The Visual Analogue Scale (VAS) for pain ranges from 0 to 100, where 0 represents no pain and 100 represents the worst imaginable pain. Higher scores indicate more severe pain.
• Pain (Visual analogue scale) [1 week after hospital discharge]: The Visual Analogue Scale (VAS) for pain ranges from 0 to 100, where 0 represents no pain and 100 represents the worst imaginable pain. Higher scores indicate more severe pain.
• Pain (Visual analogue scale) [1 month after hospital discharge]: The Visual Analogue Scale (VAS) for pain ranges from 0 to 100, where 0 represents no pain and 100 represents the worst imaginable pain. Higher scores indicate more severe pain.
• Length of stay [throughout hospitalization, expected to be 2-3 days]
• Total in-hospital opioid consumption [throughout hospitalization, expected to be 2-3 days]: opioid consumption to alleviate pain; exclude intraoperative remifentanil
• Complication [From enrollment to one month after discharge]
• Readmission [From enrollment to one month after discharge]: All-cause hospital readmission within 30 days after discharge, defined as any unplanned inpatient admission to any hospital

Other outcomes

• Heart rate variability [From discharge day to one month after discharge]: measured from wearable electrocardiography and a smart watch

Sex: Female, ages: 20 Years to 70 Years

Inclusion Criteria:

* Age between 20 and 70 years
* Scheduled to undergo gynecologic laparoscopic or robotic surgery under general anesthesia

Exclusion Criteria:

* American Society of Anesthesiologists (ASA) physical status classification IV or higher
* Body Mass Index (BMI) 35 or higher
* Presence of diabetic autonomic neuropathy
* History of esophageal hiatal hernia or delayed stomach discharge
* Known allergy to local anesthesia
* Participation in other trials that may affect study outcomes
* Inability to complete questionnaires (e.g., due to cognitive impairment)