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World J Gastrointest Surg. Feb 27, 2017; 9(2): 37-45
Published online Feb 27, 2017. doi: 10.4240/wjgs.v9.i2.37
Enhanced recovery after surgery: Current research insights and future direction
Aliza Abeles, Richard Mark Kwasnicki, Ara Darzi
Aliza Abeles, Richard Mark Kwasnicki, Ara Darzi, Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, London W2 1NY, United Kingdom
Author contributions: Abeles A and Kwasnicki RM analysed the literature and wrote the manuscript; Darzi A reviewed and edited the manuscript.
Conflict-of-interest statement: The authors have no conflict of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Richard Mark Kwasnicki, Department of Surgery and Cancer, St Mary’s Hospital, Imperial College London, 10th Floor QEQM Building, Praed Street, London W2 1NY, United Kingdom. rmk107@imperial.ac.uk
Telephone: +44-20-33122124 Fax: +44-20-33126309
Received: July 4, 2016
Peer-review started: July 12, 2016
First decision: August 11, 2016
Revised: September 14, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: February 27, 2017
Abstract

Since the concept of enhanced recovery after surgery (ERAS) was introduced in the late 1990s the idea of implementing specific interventions throughout the peri-operative period to improve patient recovery has been proven to be beneficial. Minimally invasive surgery is an integral component to ERAS and has dramatically improved post-operative outcomes. ERAS can be applicable to all surgical specialties with the core generic principles used together with added specialty specific interventions to allow for a comprehensive protocol, leading to improved clinical outcomes. Diffusion of ERAS into mainstream practice has been hindered due to minimal evidence to support individual facets and lack of method for monitoring and encouraging compliance. No single outcome measure fully captures recovery after surgery, rather multiple measures are necessary at each stage. More recently the pre-operative period has been the target of a number of strategies to improve clinical outcomes, described as prehabilitation. Innovation of technology in the surgical setting is also providing opportunities to overcome the challenges within ERAS, e.g., the use of wearable activity monitors to record information and provide feedback and motivation to patients peri-operatively. Both modernising ERAS and providing evidence for key strategies across specialties will ultimately lead to better, more reliable patient outcomes.

Keywords: Enhanced recovery after surgery, Laparoscopic surgery, Prehabilitation, Outcome measures, Technology

Core tip: Enhanced recovery after surgery (ERAS) together with laparoscopic surgery improves clinical outcomes in patients post-operatively. Prehabilitation is gaining evidence as a further method of enhancing post-operative recovery. Pre-operative programmes to improve physical function have been used and we review this early literature as well as some current issues within ERAS. Technology, which is already in use in the peri-operative period for interventions and monitoring could be used to further complement ERAS. Small, non-invasive devices which can monitor activity levels could help monitor compliance and post-operative patient activity levels as well as act as an intervention to encourage patients to increase their physical activity and thereby their post-operative outcomes.