Enhanced Recovery After Surgery: Modern Standards in Perioperative Care
DOI:
https://doi.org/10.12775/QS.2026.73.74519Keywords
enhanced recovery after surgery, ERAS, perioperative care, postoperative recovery, multimodal analgesia, length of stay, surgical outcomesAbstract
Background: Enhanced Recovery After Surgery (ERAS) protocols represent multimodal and multidisciplinary perioperative care pathways designed to reduce the physiological stress response to surgery, accelerate postoperative recovery, improve patient safety, and standardize clinical practice. The fast-track concept was first described in colorectal surgery and later developed into broader ERAS pathways that have been adapted to gastrointestinal, bariatric, thoracic, gynecologic, urologic, orthopedic, plastic, cardiac, and spine surgery .
Aim: The aim of this narrative review was to summarize the current role of ERAS protocols as modern standards in perioperative care, with particular attention to their key components, clinical outcomes, safety profile, implementation challenges, and relevance across different surgical specialties .
Materials and Methods: This narrative review was prepared on the basis of 30 peer-reviewed publications concerning ERAS protocols in different surgical settings . The analyzed studies included narrative reviews, systematic reviews, meta-analyses, randomized controlled trials, retrospective and prospective cohort studies, quality-improvement reports, and observational implementation studies. The synthesis focused on common ERAS components, postoperative length of stay, complications, readmissions, mortality, opioid use, gastrointestinal recovery, patient experience, and economic outcomes. No original patient data were collected, and no meta-analysis was performed in the present review.
References
1. Bansal T, Sharan AD, Garg B. Enhanced recovery after surgery (ERAS) protocol in spine surgery. J Clin Orthop Trauma. 2022;31:101944. doi: https://doi.org/10.1016/j.jcot.2022.101944.
2. Zwolinski NM, Patel KS, Vadivelu N, Kodumudi G, Kaye AD. ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting. Curr Pain Headache Rep. 2023;27:65–79. doi: https://doi.org/10.1007/s11916-023-01108-3.
3. Naftalovich R, Singal A, Iskander AJ. Enhanced Recovery After Surgery (ERAS) protocols for spine surgery – review of literature. Anaesthesiol Intensive Ther. 2022;54(1):71–79. doi: https://doi.org/10.5114/ait.2022.113961.
4. Martins MVDC. Are we ready for the implantation of the ERAS protocol? Rev Col Bras Cir. 2017;44(4):314–315. doi: https://doi.org/10.1590/0100-69912017004015.
5. Faulkner HR, Coopey SB, Sisodia R, Kelly BN, Maurer LR, Ellis D. Does an ERAS protocol reduce postoperative opiate prescribing in plastic surgery? JPRAS Open. 2022;31:22–28. doi: https://doi.org/10.1016/j.jpra.2021.10.006.
6. Düzgün Ö, Özcan P, Özçelik MF. Did the ERAS Protocol Improve Our Results in Locally Advanced Gastric Cancer Surgery? J Pers Med. 2022;12(10):1549. doi: https://doi.org/10.3390/jpm12101549.
7. Shalaby S, Salem R, Ward L, Fletcher C, Sgromo B. The impact of ERAS protocol on laparoscopic sleeve gastrectomy and one anastomosis gastric bypass (OAGB): analysis of length of stay (LOS), complications, and readmission. Updates Surg. 2025;77:2107–2112. doi: https://doi.org/10.1007/s13304-025-02152-x.
8. Shen W, Wu Z, Wang Y, Sun Y, Wu A. Impact of Enhanced Recovery After Surgery (ERAS) protocol versus standard of care on postoperative Acute Kidney Injury (AKI): A meta-analysis. PLoS One. 2021;16(5):e0251476. doi: https://doi.org/10.1371/journal.pone.0251476.
9. Kannan V, Ullah N, Geddada S, Ibrahiam A, Al-Qassab ZMS, Ahmed O, et al. Impact of “Enhanced Recovery After Surgery” (ERAS) protocols vs. traditional perioperative care on patient outcomes after colorectal surgery: a systematic review. Patient Saf Surg. 2025;19:4. doi: https://doi.org/10.1186/s13037-024-00425-9.
10. Tulone G, Pavan N, Abrate A, Dalmasso E, Mannone P, Baiamonte D, et al. Preliminary Results of ERAS Protocol in a Single Surgeon Prospective Case Series. Medicina (Kaunas). 2022;58(9):1234. doi: https://doi.org/10.3390/medicina58091234.
11. Prasitvarakul K, Paekaittiwong D, Tumviriyakul H, Khaimook A. ERAS protocol vs. conventional care in elective laparoscopic colorectal cancer surgery in Hatyai Hospital. Front Surg. 2025;12:1710191. doi: https://doi.org/10.3389/fsurg.2025.1710191.
12. Theja S, Mishra S, Bhoriwal S, Garg R, Bharati SJ, Kumar V, et al. Feasibility of the ERAS (Enhanced Recovery After Surgery) Protocol in Patients Undergoing Gastrointestinal Cancer Surgeries in a Tertiary Care Hospital—A Prospective Interventional Study. Indian J Surg Oncol. 2024;15(2):304–311. doi: https://doi.org/10.1007/s13193-024-01897-y.
13. Leonardi B, Sagnelli C, Fiorelli A, Leone F, Mirra R, Pica DG, et al. Application of ERAS Protocol after VATS Surgery for Chronic Empyema in Immunocompromised Patients. Healthcare (Basel). 2022;10(4):635. doi: https://doi.org/10.3390/healthcare10040635.
14. Dourado J, Wolf A, Herrera Rodriguez M, Agarwal S, Blumofe K, Moseson J, et al. ERAS protocol in colorectal surgery is effective in octogenarians: A retrospective cohort study. Surg Open Sci. 2025;24:86–91. doi: https://doi.org/10.1016/j.sopen.2025.03.004.
15. Schmid ME, Stock S, Girdauskas E. Implementation of an innovative ERAS protocol in cardiac surgery: A qualitative evaluation from patients’ perspective. PLoS One. 2024;19(5):e0303399. doi: https://doi.org/10.1371/journal.pone.0303399.
16. Lei M, Cao W, Chao T, Lu L, Fan H, Liu K. The application of ERAS Protocol in Laparoscopic Radical Cystectomy combined with Cutaneous Ureterostomy and its impact on postoperative recovery. Pak J Med Sci. 2025;41(8):2178–2185. doi: https://doi.org/10.12669/pjms.41.8.12310.
17. Swaminathan N, Kundra P, Ravi R, Kate V. ERAS protocol with respiratory prehabilitation versus conventional perioperative protocol in elective gastrectomy – a randomized controlled trial. Int J Surg. 2020;81:149–157. doi: https://doi.org/10.1016/j.ijsu.2020.07.027.
18. Soni AK, Dubey R, Baghel K, Shukla A. Impact of ERAS Protocol on Postoperative Recovery and Complications in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective Comparative Analysis. J Pharm Bioallied Sci. 2025;17:S2265–S2267. doi: https://doi.org/10.4103/jpbs.jpbs_920_25.
19. d’Astorg H, Fière V, Dupasquier M, Dutra Vieira T, Szadkowski M. Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery. Orthop Traumatol Surg Res. 2020;106(6):1167–1173. doi: https://doi.org/10.1016/j.otsr.2020.01.017.
20. Olsén MF, Andersson T, Al Nouh M, Johnson E, Block L, Vakk M, et al. Development of and adherence to an ERAS® and prehabilitation protocol for patients undergoing pancreatic surgery: An observational study. Scand J Surg. 2023;112(4):235–245. doi: https://doi.org/10.1177/14574969231186274.
21. Ackert KE, Bauerle W, Pellegrino AN, Stoltzfus J, Pateman S, Graves D, et al. Implementation of an enhanced recovery after surgery (ERAS) protocol for total abdominal hysterectomies in the division of gynecologic oncology: a network-wide quality improvement initiative. J Osteopath Med. 2023;123(10):493–498. doi: https://doi.org/10.1515/jom-2022-0204.
22. Rubinkiewicz M, Witowski J, Su M, Major P, Pędziwiatr M. Enhanced recovery after surgery (ERAS) programs for esophagectomy. J Thorac Dis. 2019;11(Suppl 5):S685–S691. doi: https://doi.org/10.21037/jtd.2018.11.56.
23. Petrucciani N, Boru CE, Lauteri G, Silecchia G. A Narrative Review on Bariatric ERAS. Chirurgia (Bucur). 2022;117(5):505–516. doi: https://doi.org/10.21614/chirurgia.2754.
24. Mangone L, Mereu F, Zizzo M, Morini A, Zanelli M, Marinelli F, et al. Outcomes before and after Implementation of the ERAS (Enhanced Recovery after Surgery) Protocol in Open and Laparoscopic Colorectal Surgery: A Comparative Real-World Study from Northern Italy. Curr Oncol. 2024;31(6):2907–2917. doi: https://doi.org/10.3390/curroncol31060222.
25. Dyas AR, Stuart CM, Bronsert MR, Kelleher AD, Bata KE, Cumbler EU, et al. Anatomic Lung Resection Outcomes After Implementation of a Universal Thoracic ERAS Protocol Across a Diverse Healthcare System. Ann Surg. 2024;279(6):1062–1069. doi: https://doi.org/10.1097/SLA.0000000000006243.
26. Sivaloganathan S, Blakeney WG, Vendittoli PA. Modernizing Total Hip Arthroplasty Perioperative Pathways: The Implementation of ERAS-Outpatient Protocol. J Clin Med. 2022;11(12):3293. doi: https://doi.org/10.3390/jcm11123293.
27. Higueras A, Gonzalez G, Bolaños ML, Redondo MV, Olazabal IM, Ruiz-Tovar J. Economic Impact of the Implementation of an Enhanced Recovery after Surgery (ERAS) Protocol in a Bariatric Patient Undergoing a Roux-En-Y Gastric Bypass. Int J Environ Res Public Health. 2022;19(22):14946. doi: https://doi.org/10.3390/ijerph192214946.
28. Radha M, Donimath K, Harshitha H, Kurdi M, Theerth K. Outcomes of Enhanced Recovery After Surgery (ERAS) Protocol Implementation in Major Gynecologic Procedures: A Prospective Case-Control Study. Cureus. 2025;17(5):e84335. doi: https://doi.org/10.7759/cureus.84335.
29. Gort N, van Gaal BGI, Tielemans HJP, Ulrich DJO, Hummelink S. Positive effects of the enhanced recovery after surgery (ERAS) protocol in DIEP flap breast reconstruction. Breast. 2021;60:53–57. doi: https://doi.org/10.1016/j.breast.2021.08.010.
30. Pędziwiatr M, Pisarska M, Kisielewski M, Major P, Mydlowska A, Rubinkiewicz M, et al. ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma: are there differences in short-term outcomes? Med Oncol. 2016;33:56. doi: https://doi.org/10.1007/s12032-016-0772-6.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Miłosz Jan Rogiński, Marek Wojciechowicz, Karol Krupiniewicz, Kacper Drążkowski, Mikołaj Kaczmarkiewicz, Jakub Serafin, Julia Kujawa, Krzysztof Rogiński, Zofia Tetłak, Karolina Rogińska

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 21
Number of citations: 0