Enhanced recovery after elective surgery. A revolution that reduces post-operative morbidity and mortality

Enhanced recovery (ER) after elective surgery has been a real revolution in peri-operative care. This concept, initially called "fast-track surgery", has evolved into "enhanced recovery or rehabilitation" (ER), which highlights the improvement of post-operative procedures rather than the simple shortening of hospital stay. The main benefit of ER is the reduction of the impact of surgical trauma with an attendant reduction of post-operative complications. This result has been demonstrated based on a good level of evidence for multiple surgical specialties. Mild complications are the most impacted by this program. The reduction in the duration of stay is thus the result of the improvement in post-operative care. This update illustrates the benefits of ER by taking three examples of elective surgery in three major surgical specialties: colorectal surgery, orthopedics and gynecological surgery. The post-operative complications impacted by ER programs and the mechanisms of this effect are also discussed.