Enhanced recovery after surgery: Progress in adapted pathways for implementation in standard and emerging surgical settings

Abstract

The concept of enhanced recovery after surgery (ERAS) has been practiced for decades and has been implemented in numerous surgical specialties. ERAS is a global surgical quality improvement initiative, and it is an element in the field of perioperative care. ERAS had shown significant clinical outcomes, patient-reported satisfaction, and improvements in medical service cost. ERAS has been developed for specific surgical procedures, but with the fast progress of newly introduced surgical procedures, the original ERAS have been developed and modified. Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status, including but not limited to pediatric surgery, laparoscopic and robotic assisted surgery, bariatric surgery, thoracic surgery, and renal transplantation. The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative, operative, and post-operative pathways. ERAS costs are higher than traditional care, but the patient’s clinical outcome and satisfaction are higher. ERAS is in progress in the fields of anesthetic tasks, pediatric surgery, and organ transplantation. Although ERAS has shown significant clinical outcomes, there are needs to modify the protocol for specific cases, hospital facilities, resources, and nurses training on elements of ERAS. Several challenges and limitations exist in the implementation of ERAS that deserve consideration, it includes: Frailty, maximizing nutrition, prehabilitation, treating preoperative anemia, and enhancing ERAS adoption globally are all included.

Keywords: Enhanced recovery after surgery; Anesthesia; Nurses; Elderly; Bowel preparation; ERAS; Perioperative nutrition; Major & ambulatory surgery

Core Tip: Enhanced recovery after surgery protocols (ERAS) is implemented in different surgical settings. The major advantage of ERAS is the early mobilization of the patient, which diminishes the possible risk of postoperative complications, including ileus and thromboembolic events. ERAS protocols include reduction of the period of hunger, acceleration of carbohydrate load, early oral feeding, and early mobilization that accelerates the recovery of normal activities, and reduces recovery time, hospital stay and hospital costs. ERAS is implemented in standard surgical settings; recently, ERAS has been successfully implemented in pediatric surgery, laparoscopy and robotic assisted surgery, and organ transplantation.