Use of Implementation Science in Enhanced Recovery After Surgery Protocols: A Scoping Review

Area of Science:

• Peri-operative Medicine
• Implementation Science
• Surgical Outcomes

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are evidence-based guidelines aimed at improving surgical patient outcomes.
• Despite proven benefits, suboptimal compliance with ERAS protocols hinders their full potential.
• Implementation science offers methods to bridge the gap between evidence and practice in healthcare.

Purpose of the Study:

• To conduct a scoping review of studies applying implementation science principles to ERAS protocols.
• To identify strategies, facilitators, and barriers associated with ERAS implementation.
• To assess the utilization of implementation science frameworks in ERAS research.

Main Methods:

• Scoping review of studies from 2001-2024 across six databases.
• Included studies explicitly used implementation science principles for ERAS pathways.
• Excluded studies focused solely on quality improvement.

Main Results:

• 34 studies met inclusion criteria, with most published recently and focused on colorectal surgery in the US.
• Building a coalition (78%) was the most common strategy, and stakeholder collaboration (59%) the most noted facilitator.
• Lack of buy-in (74%) was the primary barrier, and implementation science frameworks were underutilized (32% of studies used none).

Conclusions:

• Common strategies, facilitators, and barriers for ERAS implementation were identified.
• There is a need for increased utilization of implementation science frameworks in ERAS research.
• Applying implementation science principles can enhance ERAS protocol execution and improve patient care.