Enhanced recovery after surgery

Abstract

Despite major progress in perioperative care, the risk of post-operative complications, delayed recovery and death remains substantial. Interestingly, the initial hypothesis by George Crile in 1913 on “anoci-association” introduced the idea that blocking afferent neural input to the central nervous system might prevent post-injury organ dysfunction [1]. However, this fascinating hypothesis had limited initial clinical consequences. Over the years, the concept of “stress-free anaesthesia and surgery” was developed further [2]. However, it was rapidly recognised that the pathophysiological changes to injury were more complex and not limited to affecting the central nervous system. Thus, attention has been dedicated to the specific role of pain, fluid and blood management, reduction of the inflammatory/immunological surgical stress responses by minimal invasive surgical techniques and revision of traditional surgical care principles with unnecessary use of nasogastric tubes, drains, catheters and functional restrictions. Consequently, in 1997 and based on initial small observational studies in colonic surgery [3], the concept of “fast-track” or “ enhanced recovery” surgery was developed as a multimodal effort to reduce the need for hospitalisation and limit complications [4, 5]. This article is a short, updated narrative review based on personal views of the history, the current status and future challenges for improvement of the concept.