Enhanced Recovery After Surgery (ERAS): a systematic review and meta-analysis of clinical effectiveness across general and specialized surgical disciplines.

Introduction Enhanced Recovery After Surgery (ERAS) protocols represent a comprehensive, multidisciplinary approach to perioperative care designed to reduce physiological stress, accelerate recovery, and improve surgical outcomes. While initially implemented in colorectal surgery, ERAS programs have been adopted across multiple surgical specialties. Objective: To sys- tematically evaluate the clinical effectiveness of ERAS protocols in various surgical disciplines and to identify implementation challenges and facilitating strategies. Materials and Methods This study is a systematic review and meta-analysis con- ducted in accordance with PRISMA guidelines. A litera- ture search was performed across major databases (Pub- Med, Scopus, Web of Science, Cochrane Library) to identify studies from January 2015 to March 2024 com- paring ERAS protocols (with ≥5 standard components) to conventional perioperative care in adults. Primary out- comes included length of stay (LOS), postoperative com- plications, opioid consumption, pain scores, time to bowel function recovery, and readmission rates. Data were pooled using random/fixed-effects models. Results A total of 45 studies involving 25,637 patients were in- cluded. ERAS significantly reduced LOS (mean differ- ence: –2.4 days; 95% CI: 1.9–3.0), postoperative compli- cation rates (RR: 0.70; 95% CI: 0.58–0.85), and opioid consumption (mean reduction: –16.2 mg morphine- equivalent). ERAS protocols also improved early mobi- lization and gastrointestinal function recovery without in- creasing readmission or mortality. Subgroup analysis re- vealed the most substantial benefits in colorectal and gy- necologic surgeries. Conclusion ERAS protocols are associated with superior clinical out- comes, reduced opioid use, and shorter hospital stays. Broad implementation, context-specific adaptation, and continuous quality monitoring are essential for maximiz- ing their impact across surgical disciplines.