Andrew F. Stasic, Stephen F. Dierdorf
Sentinel studies by Bartram and Kehlet challenged the acceptance of the inevitable consequences of the adverse physiologic effects of the stress response to surgery. This led to the evolution of Enhanced Recovery after Surgery (ERAS) protocols. ERAS is a multi-disciplinary approach aimed at improving care of the surgical patient? ERAS protocols/pathways were developed by the application of sound scientific knowledge to perioperative care. ERAS protocols have been shown to reduce postoperative complications, reduce hospital length of stay, and reduce costs. Although some ERAS protocols are highly specific to the type of surgery, issues common to most of the protocols are pain management, perioperative nutrition, control of nausea and emesis, antimicrobial therapy, thromboembolism prophylaxis, and precise perioperative fluid administration. Protocols often introduce multiple changes to clinical practice simultaneously and, if a positive effect is found, it is difficult to determine the contribution of each component.