The Role of Enhanced Recovery After Surgery Protocols in Cleft and Craniofacial Surgery: Update From the American Society of Craniofacial Surgeons

Enhanced Recovery After Surgery, or ERAS, was described by Kehlet in the 1990s. At first these programs focus on addressing preoperative, intraoperative, and postoperative factors to improve surgical outcomes in cardiac and colorectal procedures. Over the ensueing decades, many other surgical specialties within orthopedic surgery, gynecology, and surgical oncology have adopted the ERAS concepts and developed ERAS protocols. The ERAS approach is evidence-based, data-driven, leveraging group experience, and group intelligence. Recognizing the lack of ERAS protocols in craniomaxillofacial surgery, efforts for their development begun in 2019, jointly between members of the American Society of Craniofacial Surgeons (ASCFS) and the American Society of Maxillofacial Surgeons (ASMS). To date, ERAS protocols for the following procedures have been developed and released during national meetings: repair of cleft lip, palatoplasty, secondary alveolarbone graft, orthognathic surgery, and fronto-orbital advancement. The ERAS protocols address 4 phases: pre-hospital, pre-operative, intra-operative, and post-operative. These are living documents in that there is a closed feedback loop with interative evaluation followed by modification. As technology improves and more data become available, better treatments should replace existing ones. These protocols are developed by craniofacial surgeons for craniofacial units to improve patient outcomes.