The use of enhanced recovery after surgery (ERAS) protocols in plastic surgery: A systematic review and meta-analysis of the literature.

BACKGROUND

Enhanced recovery after surgery (ERAS) protocols, introduced in 1997, are evidence-based strategies designed to reduce postoperative stress and improve recovery through a multidisciplinary approach. This systematic review evaluated the use of ERAS in plastic surgery, focusing on opioid use, pain management, hospital stay, and patient outcomes.

METHODS

A literature search in PubMed/MEDLINE and Web of Science was conducted up to May 9, 2024, identifying 239 studies on ERAS in plastic surgery. Seventeen studies met the inclusion criteria, and 9 studies involving 1228 patients were included. Outcomes assessed were narcotic use, pain scores, hospital stay, and complications. Quality was assessed using the National Institute of Health (NIH) tool.

RESULTS

Among the 9 studies, 4 were included in a meta-analysis (600 participants). ERAS protocols were associated with a significantly shorter hospital stay (mean difference: -0.58 days, P = 0.003) with no heterogeneity. Opioid use decreased (mean difference: -85.5 morphine milligram equivalents [MME]), although the results were uncertain due to high heterogeneity (I² = 99.9). ERAS also showed lower pain scores within 24 h postsurgery, but with considerable variability (mean difference: -1.56, P = 0.27).

CONCLUSION

ERAS protocols reduce opioid consumption and hospital stays while maintaining or improving patient satisfaction in plastic surgery. Despite risks such as increased bleeding, the benefits suggest that ERAS enhances recovery. Future research should optimize protocols and address regional implementation challenges.