Challenges and opportunities in enhanced recovery after surgery programs: An overview.

Enhanced Recovery After Surgery (ERAS) programs were developed as evidence-based, multi-disciplinary interventions in all the perioperative phases to minimise the surgical stress response, reduce complications, and enhance outcomes. The results across various surgical procedures have been positive, with a reduction in medical complications, a reduction in length of hospital stay, and a reduction in care costs without increased re-admission rates. However, implementation for many institutions has not been easy and suboptimal at best. The robust and pervasive adoption of these programs should be based on effective change management, dynamic and engaged clinical leadership, adherence to the principles of continuous quality improvement programs, and the adoption of evidence-based and data-driven changes in pathway development and implementation. Rapid cycle, randomised/quasi-randomised quality improvement projects must be the core foundation of an ERAS program. Finally, research methodologies should focus on controlling for adherence to the core elements of the pathways and testing for the effectiveness of an individual intervention in a randomised controlled trial.