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

Enhanced recovery after surgery (ERAS) protocols are evidence-based guidelines for the peri-operative management of surgical patients that have been shown to improve clinical outcomes. However, adequate compliance to ERAS protocols is often lacking, limiting their benefit for patients and healthcare systems. Implementation science may help to bridge this evidence-to-practice gap.

We conducted a scoping review of studies explicitly employing implementation science principles pertaining to pathways denoted as "ERAS" in the surgical field across six databases from 2001 to 2024. Data were abstracted on implementation science strategies, facilitators, and barriers for ERAS protocols, as well as implementation science frameworks employed in planning or evaluation. Given the aim to investigate utilization of implementation science principles, studies rooted solely in quality improvement were excluded.

A total of 34 studies met inclusion criteria. The majority (62%) were published in the last 5 years. Studies were most often conducted in the United States and within colorectal surgery. The most common strategy was building a coalition (n = 14/18, 78%), and the most noted facilitator was collaboration among stakeholders (n = 13/22, 59%). Conversely, the most common barrier was lack of buy-in (n = 25/34, 74%). A total of 9 frameworks were employed across 23 of the studies, although 11 (32%) of the studies did not use any framework.

Common strategies, facilitators, and barriers pertaining to ERAS implementation were identified. However, utilization of implementation science frameworks remains limited. Leveraging implementation science principles, such as applying proven strategies and anticipating common barriers, may improve execution of ERAS protocols in the future.