Beyond procedure-specific protocols: a systematic review identifying a universal anaesthesiological core across...

Enhanced Recovery After Surgery (ERAS) Society guidelines provide procedure-specific, evidence-based recommendations for perioperative care. Many interventions fall within anaesthesiology, yet the extent to which they reflect cross-speciality principles remains unclear. The objective of this systematic review was to identify a universal anaesthesiological core across ERAS guidelines.

All ERAS Society guidelines were screened for eligibility. Guidelines were excluded if they had no practical anaesthesiological recommendations, had been superseded, or were not intended for standard hospital settings. A classification of 45 anaesthesiological umbrella terms was developed through pilot extraction and Delphi consensus. Two reviewers independently extracted recommendations and their strength. Methodological quality was assessed using Appraisal of Guidelines for Research and Evaluation II (AGREE II). Umbrella terms were classified as consistent (>80%), mostly consistent (60-80%), mixed (20-60%), or sparse (≤20%).

Of 39 publications, 24 guidelines (2013-2025) were included. Anaesthesiological involvement was identifiable in 23 out of 24 guidelines. Of the 45 umbrella terms, eight were consistent, 10 mostly consistent, 16 mixed, and 11 sparse. The consistent domains were: multimodal analgesia, fasting, thromboprophylaxis, antimicrobial prophylaxis, nutrition, temperature and fluid management, and surgery-specific recommendations. The mean AGREE II score was 76%, highest for scope and purpose and clarity of presentation and lowest for stakeholder involvement.

Despite procedural heterogeneity, a consistent anaesthesiological core is identifiable within the ERAS guidelines. Cross-guideline consistency identifies the priority domains for cross-speciality implementation, whereas recommendation strength independently indicates the confidence with which guidance transposes onto local practice; high-frequency, mixed-strength domains, notably fluid management, preoperative carbohydrate administration and preanaesthetic medication, warrant structured local appraisal.

The study protocol: Open Science Framework (DOI: 10.17605/OSF.IO/CBWDT).