Post-surgical diets in the ERAS protocol: D-ERAS scoping review

Area of Science:

• Surgical Nutrition
• Enhanced Recovery Pathways
• Postoperative Care

Background:

• Enhanced Recovery After Surgery (ERAS) programs incorporate early oral feeding (EOF) to accelerate patient recovery.
• Current ERAS guidelines suggest resuming oral intake within 24 hours post-surgery but lack specifics on diet progression and composition.

Purpose of the Study:

• To conduct a scoping review of postoperative oral feeding protocols (OFPs) used in various abdominal surgeries.
• To analyze adherence to ERAS recommendations within existing OFPs and identify inconsistencies.

Main Methods:

• A comprehensive literature search was performed using PubMed and Scopus databases.
• Sixty-eight articles detailing OFPs for esophageal, gastric, hepatobiliary, pancreatic, colorectal, urologic, and gynecologic surgeries were included and synthesized thematically.

Main Results:

• Many included studies initiated oral feeding later than the ERAS-recommended 24-hour timeframe.
• Protocols often commenced with liquids and progressed slowly, even for surgeries where solid food initiation is encouraged.
• Significant inconsistencies and a lack of standardized terminology regarding diet composition (energy, nutrients, food types, meal frequency) were identified across studies.

Conclusions:

• There is considerable non-adherence to ERAS guidelines regarding the timing and progression of postoperative oral feeding.
• The lack of standardized OFPs and detailed dietary descriptions presents a barrier to implementing evidence-based nutritional strategies within ERAS pathways.