RICA pathway (Enhanced Recovery After Surgery for Adults). 2026 update: Executive summary

The objective of the Continuous Update Project of the RICA Pathway (Enhanced Recovery After Surgery in Adults) is to maintain updated and consensual recommendations based on scientific evidence, facilitating their implementation and evaluation. The project was developed between November 2021 and October 2025, focusing on elective major surgery in adults. Evidence was evaluated using the GRADE methodology, with reviews in PubMed, Embase, and the Cochrane Library, including systematic reviews, meta-analyses, randomised clinical trials, consensus guidelines, and multicenter studies. The project was structured into a coordinating group, a consulting group, and various reviewing groups, and the recommendations were evaluated and accepted by consensus. 103 recommendations were approved, compared to 135 in the 2021 edition. 83% of these presented high or moderate evidence, and 76% had a strong grade of recommendation in favor. The recommendations were grouped into sets of measures ("bundles") to improve their applicability.