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Surgery Research and Practice
Volume 2016, Article ID 3561249, 6 pages
Review Article

Future Perspectives of ERAS: A Narrative Review on the New Applications of an Established Approach

12a Anestesia Anestesia, Rianimazione e Terapia del Dolore, Azienda Ospedaliero Universitaria, Via Gramsci 14, 43126 Parma, Italy
2Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43126 Parma, Italy
3SIMPAR Group (Study in Multidisciplinary Pain Research), Italy
4U.O. Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138 Bologna, Italy

Received 31 March 2016; Accepted 14 June 2016

Academic Editor: Ramón Vilallonga

Copyright © 2016 Dario Bugada et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


ERAS approach (Enhanced Recovery After Surgery) is a multimodal, perioperative pathway designed to achieve early recovery after surgery. ERAS has shown documented efficacy in elective surgery, and the concept of “multimodal” and “multidisciplinary” approach seems still to be of higher importance than each single item within ERAS protocols. New perspectives include the use of ERAS in emergency surgery, where efficacy and safety on outcome have been documented, and flexibility of traditional items may add benefits for traditionally high-risk patients. Obstetric surgery, as well, may open wide horizons for future research, since extremely poor data are currently available, and ERAS benefits may translate even on the baby. Finally, the concept of “outcome” may be extended when considering the specific setting of cancer surgery, in which variables like cancer recurrence, early access to adjuvant therapies, and, finally, long-term survival are as important as the reduced perioperative complications. In this perspective, different items within ERAS protocols should be reinterpreted and eventually integrated towards “protective” techniques, to develop cancer-specific ERAS approaches keeping pace with the specific aims of oncologic surgery.