Challenges and opportunities in enhanced recovery after surgery programs: An overview

Area of Science:

• Perioperative Medicine
• Surgical Outcomes Research
• Healthcare Management

Background:

• Enhanced Recovery After Surgery (ERAS) programs are evidence-based, multidisciplinary interventions designed to minimize surgical stress, reduce complications, and improve patient outcomes across all perioperative phases.
• While ERAS programs have demonstrated positive results, including decreased medical complications, shorter hospital stays, and reduced costs without increased readmissions, their widespread implementation has been challenging.

Purpose of the Study:

• To highlight the critical components necessary for the robust and pervasive adoption of ERAS programs.
• To emphasize the importance of effective change management, clinical leadership, and continuous quality improvement in ERAS implementation.
• To guide future research methodologies for evaluating ERAS interventions.

Main Methods:

• Review of evidence-based practices and principles of change management in healthcare.
• Emphasis on continuous quality improvement (CQI) frameworks, including rapid cycle, randomized/quasi-randomized quality improvement projects.
• Discussion of research methodologies for pathway development and implementation, focusing on adherence and individual intervention effectiveness.

Main Results:

• ERAS programs are associated with significant reductions in medical complications and length of hospital stay.
• Successful ERAS implementation is contingent upon effective change management, engaged clinical leadership, and data-driven pathway development.
• Suboptimal implementation is common, indicating a need for structured approaches to adoption.

Conclusions:

• Robust adoption of ERAS programs necessitates a foundation in effective change management and continuous quality improvement.
• Future research should prioritize controlling for adherence to core ERAS elements and employ randomized controlled trials to assess individual intervention effectiveness.
• Engaged clinical leadership and data-driven pathway adjustments are crucial for maximizing the benefits of ERAS programs.