Evidence Synthesis of Enhanced Recovery After Surgery Protocols: Evaluating Optimal Components and Cross-Specialty Effectiveness

Background: Enhanced Recovery After Surgery (ERAS) protocols had been optimized for perioperative care through multimodal, evidence-based strategies, minimizing surgical stress, preserving function, and accelerating recovery. Despite widespread adoption, optimal components and cross-specialty effectiveness had remained underexplored, necessitating coalescence. This systematic review had been conducted to evaluate the effectiveness of ERAS in the improvement of postoperative outcomes - length of stay (LOS), complications, readmission, and mortality - following major surgery, with critical components and implementation determinants having been identified. Methods: Adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines had been maintained, and 52 systematic reviews/meta-analyses and 18 cohort studies from PubMed, Embase, Cochrane Library, Scopus, and Web of Science (January 2018 to May 2023) had been analyzed. Data on ERAS components, outcomes, and implementation factors had been compiled narratively. Methodological quality had been assessed using AMSTAR 2 for reviews and the Newcastle-Ottawa Scale for cohort studies. Results: A mean reduction in hospital LOS of 1.5 days had been demonstrated by ERAS protocols, along with a 35% decrease in overall complications when compared to conventional care. The core components had been identified as preoperative carbohydrate loading, opioid-sparing analgesia, and early mobilization. No significant effects had been observed on 30-day readmission or mortality. Heterogeneity had been attributed to variable protocol compliance and inter-specialty differences. Conclusions: ERAS protocols had significantly improved postoperative recovery, reducing hospital LOS and complication rates across surgical disciplines. Successful implementation had required strict adherence to evidence-based components and structured compliance. Future research should prioritize standardization, long-term outcome assessment, and mitigating implementation barriers to maximize efficacy.