Enhanced Recovery after Surgery (ERAS): Moving Beyond the Scalpel to Improve Patient Outcomes
1Dr Munawer Latif Memon, 2Dr Naeem Akhtar, 3Dr Muhammad Saqib, 4Dr Umair Ahmed Khan, 5Dr Muhammad Ikram
Submission: 02 January 2026 | Acceptance: 04 February 2026 | Publication: 03 April 2026,
1Associate professor of surgery, Wah Medical college, POF Hospital, Wah Cantt.
2Associate professor of surgery, wah medical college,POF Hospital, wah Cantt.
3Senior registrar surgery, Wah Medical college, POF Hospital, Wah Cantt.
4Assistant professor of surgery, wah medical college, POF Hospital, Wah Cantt.
5Associate professor of orthopaedics, wah medical college, POF Hospital, Wah Cantt.
Abstract
Enhanced Recovery After Surgery (ERAS) has emerged as a transformative, evidence-based paradigm in perioperative medicine, shifting focus from isolated operative technique to a holistic, multimodal approach that optimizes patient outcomes across the entire surgical pathway. This review synthesizes recent advances and strategies in ERAS, drawing from systematic literature searches (PubMed, Scopus; 2015-2024) and high-quality evidence including meta-analyses, randomized controlled trials, and large cohort studies. Key components preoperative optimization (nutrition, prehabilitation, carbohydrate loading, smoking/alcohol cessation, patient education, multidisciplinary team coordination, VTE prophylaxis, and reduced fasting), intraoperative management (opioid-sparing anesthesia, goal-directed fluid therapy, multimodal analgesia, hypothermia prevention, optimal positioning), and postoperative interventions (early mobilization, prompt feeding/drain removal, PONV prophylaxis, glycemic control) work synergistically to attenuate the surgical stress response, preserve homeostasis, and accelerate functional recovery. High-level evidence consistently demonstrates ERAS reduces hospital length of stay by 1-3 days, postoperative complications by 30-50%, readmissions and mortality (neutral or improved), and healthcare costs by $600–$2,000+ per patient, with benefits amplified by protocol compliance (>80% adherence yields maximal gains). Specialty-specific applications in colorectal, gynecologic, orthopedic, urologic, pancreatic, and cardiac surgery highlight broad applicability, while challenges such as resistance to change, resource limitations, and variable adherence are mitigated through audits, education, and quality improvement. Emerging trends digital monitoring, AI-driven personalization, and expansion to emergency and frail populations promise further refinement. By moving beyond the scalpel, ERAS represents a patient-centered, value-driven evolution in surgical care, fostering faster recovery, reduced morbidity, enhanced satisfaction, and sustainable healthcare delivery.
Keywords: Enhanced Recovery after Surgery (ERAS), Perioperative Care, Multimodal Analgesia, Postoperative Complications, Hospital Length of Stay