Enhanced Recovery After Surgery (ERAS): Transforming Orthopedic Trauma Management

Enhanced Recovery After Surgery (ERAS) protocols represent a paradigm shift in perioperative care, emphasizing evidence-based multidisciplinary approaches to optimize surgical outcomes. This narrative review examines the current evidence for ERAS implementation in orthopedic trauma care by synthesizing literature from major medical databases. The ERAS protocols in patients with hip fractures demonstrate robust evidence for improved outcomes, including reduced hospital length of stay, decreased complication rates, lower delirium and infection rates, and improved pain control with reduced opioid consumption. Emerging evidence for ankle and other extremity fractures shows similar benefits, including a faster return to function and improved patient satisfaction. The key ERAS components include preoperative optimization, intraoperative stress reduction, and aggressive postoperative mobilization. Despite compelling evidence, implementation remains challenging because of resource limitations, knowledge gaps, organizational barriers, and the unpredictable nature of trauma care. Successful ERAS programs require dedicated multidisciplinary teams, institutional commitment, clear protocols, ongoing education, and robust measurement systems. As the evidence base expands and implementation science advances, ERAS has the potential to become the standard of care for trauma patients worldwide, with future directions including technology integration, precision medicine approaches, and adaptation to resource-limited settings to further enhance the reach and effectiveness of these protocols.