If enhanced recovery after surgery improves outcomes, why is it not consistently applied in clinical practice?

INTRODUCTION Enhanced recovery after surgery (ERAS) protocols aim to optimise patient recovery by minimising postoperative complications and shortening hospital stays. Despite their widespread implementation, adherence to ERAS protocols, their overall impact on postoperative outcomes, and the role of individual components in improving outcomes are not yet fully explored. AIM The aim of this scoping review is to map the existing evidence on compliance with ERAS protocol and describe how improving the compliance rate might improve postoperative outcomes. In addition, it is important to understand why patients and clinicians move away from adherence to such programmes to help bridge the gap between ERAS guidelines and clinical practice. METHODS AND ANALYSIS The protocol was registered with the Open Science Framework. The scoping review will follow the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. A systematic search will be conducted using MEDLINE (OVID), Embase (OVID), and Cochrane databases, covering studies published between January 2014 and June 2024. Data synthesis will be descriptive, mapping study characteristics, ERAS elements, and whether outcomes and compliance were reported. No statistical analysis will be conducted; instead, findings will be organised in a narrative manner by surgical specialty to highlight variations in compliance and outcomes. A descriptive and explanatory approach will be used to summarise findings in line with the review objectives. DISCUSSION AND CONCLUSION This scoping review will map the evidence on ERAS compliance and its potential impact on postoperative outcomes. Understanding what determines compliance and outcomes could lead to new opportunities for improving clinical outcomes, especially for patients with complex needs, and contribute to greater healthcare.