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Enhanced recovery in gynecologic surgery: institutional challenges and implementation framework.
Paula Mateo-Kubach1, M Clara Santía2, Tommaso Meschini3
1Houston Methodist Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Houston, TX, USA; Universidad Autónoma de Madrid, Doctoral School, Madrid, Spain.
Summary
Enhanced recovery after surgery (ERAS) protocols improve patient outcomes but face inconsistent real-world adherence. This review offers strategies to overcome implementation barriers for successful ERAS adoption and sustained quality improvement.
Area of Science:
- Peri-operative medicine
- Surgical care pathways
- Healthcare quality improvement
Background:
- Enhanced Recovery After Surgery (ERAS) protocols are evidence-based guidelines designed to minimize surgical stress and accelerate patient recovery.
- Despite proven benefits, consistent implementation and adherence to ERAS protocols remain a significant challenge in clinical practice.
- Variability in adherence rates exists across different healthcare institutions and geographical regions.
Purpose of the Study:
- To provide practical insights and a framework for overcoming common barriers to ERAS protocol implementation.
- To address challenges related to patient adherence, healthcare provider engagement, workflow integration, and documentation within ERAS programs.
- To offer actionable strategies for achieving long-term success and data-driven quality improvement in ERAS initiatives.
Main Methods:
- This review synthesizes existing literature and practical experiences concerning ERAS implementation.
- It focuses on identifying core challenges in evaluating ERAS protocol compliance.
- Peri-operative measures and potential solutions for implementation barriers are outlined.
Main Results:
- Real-world implementation of ERAS protocols is inconsistent, with significant variations in adherence.
- Key challenges include patient adherence, provider buy-in, seamless workflow integration, and accurate documentation.
- Successful ERAS adoption requires more than protocol design; it necessitates institutional support, clear communication, education, and local adaptation.
Conclusions:
- Overcoming barriers to ERAS protocol compliance is crucial for realizing its full potential in improving surgical outcomes.
- A pragmatic, data-driven approach focusing on institutional support and adaptive strategies is essential for successful and sustained ERAS implementation.
- Future efforts should focus on practical solutions to enhance adherence and optimize peri-operative care through ERAS pathways.
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