Enhanced recovery after surgery (ERAS) programs are increasingly being embraced worldwide because they have been shown to reduce postoperative complications and hospital length of stay without increasing post-discharge readmission rates.1,2 Although ERAS programs should become standard of care, implementation has been slow and has low compliance with various components.2,3 The reasons for the lack of implementation or patchy implementation are several; however, conflicting recommendations may be a major factor.
So, why is there so much variation in recommendations, even though the same published evidence is used to develop them?
Most recommendations are developed systematically using well-recognized approaches for identifying and analyzing the available evidence. Systematic reviews/meta-analyses are considered the highest level of evidence. Developing a systematic review involves performing exhaustive literature searches, appropriate selection of studies based on eligibility criteria, grading the included studies and presenting the recommendations in a clinically applicable manner.4
Although the...
