Enhanced recovery after surgery (ERAS) in clinical practice

Abstract

‘Enhanced Recovery After Surgery’ (ERAS) protocols are an evidence-based, multidisciplinary system for patient care that— since its emergence in 2001— has shown remarkable efficacy in reducing surgical complications, shortening length of stay (LoS), and the incidence of hospital re-admission. Unfortunately, wide spread acceptance of ERAS has been slow, as it conflicts with some traditional perioperative care practices. However, with protocol compliance >70%, studies have shown significant reduction in mortality and postsurgical complications, with 30-50% reduction in LoS and approximately a 50% reduction in complications. A primary objective of ERAS protocols is to maintain anabolic homeostasis, preventing protein breakdown, muscle loss, and insulin resistance. One key element of the ERAS protocol is the implementation of an auditing system to ensure compliance with the elements of the guidelines published by the international ERAS Society. This component of ERAS is essential for not only optimizing adherence, but also for the continuous updating of protocols to meet current evidence-based best practices. Through the implementation of the ERAS program, it is possible to facilitate the highest possible quality of patient outcomes and provide informed, modernized care. The content of this review will focus on the key elements of the ERAS protocol and institutional acceptance and implementation.