Enhanced recovery after surgery

Clinical management, complication rates and lengths of stay differ significantly for the same types of operations among different centers, despite the fact that the discharge criteria are almost always the same. This is the result of different perioperative management of the patients. The "Enhanced recovery after surgery'' protocol was started by five northern European universities in 2001 for the clinical management of colonic resections because of the need to develop a consensus on key elements of perioperative care. Their results showed that the recovery period can be shortened after major surgical operations. However, effects on morbidity and mortality remain to be determined. This protocol also showed us that the traditional clinical management elements like preoperative fasting, anesthesia route and bowel preparation are open for discussion because the current approaches are radically different with better outcomes. The protocol is limited to a few countries but the results are promising. Although it is not easy to change the traditional applications in surgery, we have to be aware of the current approaches. This review is about the "Enhanced recovery after surgery'' protocol's details and current results. By this way we can adopt the results for our current and future clinical trials in an evidence based manner for the enhancement of recovery.