Evidence-Based Enhanced Recovery After Surgery (ERAS): Multidisciplinary Strategies for Optimizing Perioperative Outcomes and Surgical Recovery
DOI:
https://doi.org/10.64784/255Palabras clave:
Enhanced Recovery After Surgery, ERAS, perioperative medicine, perioperative care, multimodal analgesia, prehabilitation, postoperative recovery, evidence-based surgery, patient safety, surgical outcomes, multidisciplinary care, quality improvementResumen
Enhanced Recovery After Surgery (ERAS) has become a fundamental approach in contemporary perioperative medicine by integrating multidisciplinary, evidence-based interventions designed to reduce surgical stress, accelerate functional recovery, and improve clinical outcomes. This review analyzed current scientific evidence regarding the physiological foundations, perioperative components, clinical effectiveness, and international implementation of ERAS protocols across different surgical specialties. Relevant literature was examined from major biomedical databases and international clinical guidelines, prioritizing clinical practice guidelines, systematic reviews, meta-analyses, clinical studies, and consensus documents addressing enhanced recovery and perioperative care. The evidence reviewed indicates that ERAS pathways are associated with reductions in postoperative complications and hospital length of stay, earlier restoration of gastrointestinal function and mobility, decreased opioid requirements, and more efficient utilization of healthcare resources. Favorable outcomes were observed across colorectal, hepatobiliary, pancreatic, thoracic, gynecologic, urologic, orthopedic, and other surgical fields, although their magnitude varied according to procedure complexity, patient characteristics, institutional resources, and protocol adherence. Greater compliance with ERAS components was consistently associated with better postoperative outcomes, emphasizing the importance of multidisciplinary collaboration, standardized clinical pathways, professional education, and continuous quality improvement. Despite persistent implementation barriers, particularly in resource-constrained healthcare systems, the principles of enhanced recovery can be adapted to different institutional environments, including those in Latin America. ERAS therefore represents an evolving model of evidence-based surgical care capable of improving patient safety, functional recovery, and healthcare efficiency. Future developments involving personalized perioperative medicine, digital monitoring, predictive analytics, and emerging technologies may further strengthen enhanced recovery pathways and support their broader implementation worldwide.
Referencias
• Batchelor, T. J. P., Rasburn, N. J., Abdelnour-Berchtold, E., Brunelli, A., Cerfolio, R. J., Gonzalez, M., Ljungqvist, O., Petersen, R. H., Popescu, W. M., & Slinger, P. D. (2019). Guidelines for enhanced recovery after lung surgery: Recommendations of the ERAS Society and the European Society of Thoracic Surgeons. European Journal of Cardio-Thoracic Surgery, 55(1), 91–115.
• Carli, F., & Scheede-Bergdahl, C. (2015). Prehabilitation to enhance perioperative care. Anesthesiology Clinics, 33(1), 17–33.
• Fearon, K. C. H., Ljungqvist, O., Von Meyenfeldt, M., Revhaug, A., Dejong, C. H., Lassen, K., Nygren, J., Hausel, J., Soop, M., Andersen, J., & Kehlet, H. (2005). Enhanced recovery after surgery: A consensus review of clinical care for patients undergoing colonic resection. Clinical Nutrition, 24(3), 466–477.
• Feldheiser, A., Aziz, O., Baldini, G., Cox, B. P. B. W., Fearon, K. C. H., Feldman, L. S., Gan, T. J., Kennedy, R. H., Ljungqvist, O., Lobo, D. N., Miller, T. E., Radtke, F. M., Ruiz Garces, T., Schricker, T., Scott, M. J., Thacker, J. K., Ytrebø, L. M., & Carli, F. (2016). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: Consensus statement. Acta Anaesthesiologica Scandinavica, 60(3), 289–334.
• Gustafsson, U. O., Scott, M. J., Schwenk, W., Demartines, N., Roulin, D., Francis, N., McNaught, C. E., MacFie, J., Liberman, A. S., Soop, M., Hill, A., Kennedy, R. H., Lobo, D. N., Fearon, K., & Ljungqvist, O. (2013). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World Journal of Surgery, 37(2), 259–284.
• Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., … Ljungqvist, O. (2019). Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World Journal of Surgery, 43(3), 659–695.
• Gustafsson, U. O., Rockall, T. A., Wexner, S., How, K. Y., Emile, S., Marchuk, A., Fawcett, W. J., Sioson, M., Riedel, B., Chahal, R., Balfour, A., Baldini, G., de Groof, E. J., Romagnoli, S., Coca-Martinez, M., Grass, F., Brindle, M., & Hubner, M. (2025). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025. Surgery, 184, 109397.
• Irani, J. L., Hedrick, T. L., Miller, T. E., Lee, L., Steinhagen, E., Shogan, B. D., Goldberg, J. E., Feingold, D. L., Lightner, A. L., & Paquette, I. M. (2023). Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surgical Endoscopy, 37(1), 5–30.
• Kehlet, H. (1997). Multimodal approach to control postoperative pathophysiology and rehabilitation. British Journal of Anaesthesia, 78(5), 606–617.
• Kehlet, H., & Wilmore, D. W. (2008). Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery. Annals of Surgery, 248(2), 189–198.
• Lassen, K., Coolsen, M. M. E., Slim, K., Carli, F., de Aguilar-Nascimento, J. E., Schäfer, M., Parks, R. W., Fearon, K. C. H., Lobo, D. N., Demartines, N., & Ljungqvist, O. (2013). Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. World Journal of Surgery, 37(2), 240–258.
• Ljungqvist, O., Scott, M., & Fearon, K. C. H. (2017). Enhanced Recovery After Surgery: A Review. JAMA Surgery, 152(3), 292–298.
• Ljungqvist, O., de Boer, H. D., Balfour, A., Fawcett, W. J., Lobo, D. N., Nelson, G., Scott, M. J., Thorell, A., & Hubner, M. (2021). Opportunities and challenges for the next phase of Enhanced Recovery After Surgery: A review. JAMA Surgery, 156(8), 775–784.
• Melloul, E., Hübner, M., Scott, M., Snowden, C., Prentis, J., Dejong, C. H. C., Garden, O. J., Farges, O., Kokudo, N., Vauthey, J. N., Clavien, P. A., Demartines, N., & Lassen, K. (2016). Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World Journal of Surgery, 40(10), 2425–2440.
• Miller, T. E., Roche, A. M., & Mythen, M. (2015). Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Canadian Journal of Anesthesia, 62(2), 158–168.
• Myles, P. S., & Mythen, M. G. (2023). Perioperative medicine: Recent advances and future directions. The Lancet, 401(10378), 1093–1106.
• Nelson, G., Altman, A. D., Nick, A., Meyer, L. A., Ramirez, P. T., Achtari, C., Antrobus, J., Huang, J., Scott, M., Wijk, L., Acheson, N., Ljungqvist, O., & Dowdy, S. C. (2016). Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Gynecologic Oncology, 140(2), 313–322.
• Powers, B. K., Ponder, H. L., Findley, R., Wolfe, R., Patel, G. P., & Parrish, R. H. (2024). Enhanced recovery after surgery (ERAS®) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items. World Journal of Surgery, 48(3), 509–523.
• Rollins, K. E., & Lobo, D. N. (2016). Intraoperative goal-directed fluid therapy in elective major abdominal surgery: A meta-analysis. Annals of Surgery, 263(3), 465–476.
• Thiele, R. H., Rea, K. M., Turrentine, F. E., Friel, C. M., Hassinger, T. E., McMurry, T. L., Sarosiek, B. M., & Hedrick, T. L. (2015). Standardization of care: Impact of an Enhanced Recovery Protocol on length of stay, complications, and direct costs after colorectal surgery. Journal of the American College of Surgeons, 220(4), 430–443.
