Opportunities and Challenges for the Next Phase of Enhanced Recovery After Surgery A Review

This narrative review describes how Enhanced Recovery After Surgery (ERAS) has continued to develop since inception, opportunities and challenges in the field of enhanced recovery today, and how ERAS represents an opportunity to manage the problems for surgery arising from the COVID-19 pandemic. Importance Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion. Observations Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low- and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. Conclusions and Relevance To date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

Automated summary

This narrative review discusses the development, opportunities, and challenges in the field of Enhanced Recovery After Surgery (ERAS) today. While ERAS has played a significant role in global surgical quality improvement, further improvements are still needed, especially in patient optimization and systematic implementation.