Enhanced recovery after surgery (ERAS) pathways, or enhanced recovery pathways (ERPs), involve multi-disciplinary, multimodal evidence-based interventions that attenuate the surgical stress response and maintain perioperative physiological function, and thus reduce postoperative complications and accelerate recovery.1 ERPs have been successfully integrated in routine perioperative care in several European medical centers for more than a decade, and in recent years they are increasingly embraced in a variety of disciplines in the United States. In this article, we discuss the current controversies of ERPs with the hope that the medical centers which plan to implement these programs use the updated evidence in their practice, as comprehensive reviews and guidelines published in recent years have not always included the updated information.2
Significant new knowledge has been gained since the original ERPs were introduced in the early 1990s. However, several elements proposed in many guidelines are now considered non-essential or unnecessary (e.g., avoidance...
