Despite the general agreement that implementation of Enhanced Recovery After Surgery (ERAS) pathways decrease hospital length of stay, a continuous challenge that has often been neglected is a procedure- and patient-specific approach. For example, asking ‘Why is the patient still in hospital?’ is the original premise for ERAS. Outcomes improve with increased compliance with recommended elements, but overcomplication of pathways can lead to cherry picking of elements that are convenient, resulting in ‘partial ERAS’. As there are few high-quality randomised clinical trials (RCTs) that evaluate the specific role of individual preoperative, intraoperative, and postoperative elements, challenges lie ahead to identify essential ERAS elements to facilitate more widespread implementation. To achieve this goal, the balance between large RCTs and smaller detailed hypothesis-generating observational studies needs to be addressed in order to enhance knowledge and limit waste of research resources.

中文翻译：

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加速康复外科 （ERAS） 研究的挑战


尽管人们普遍认为实施加速康复术后 （ERAS） 途径会缩短住院时间，但一个经常被忽视的持续挑战是特定于手术和患者的方法。例如，问“为什么病人还在医院”是 ERAS 的原始前提。结果随着对推荐要素的依从性提高而改善，但途径的过度复杂会导致挑选方便的要素，从而导致“部分 ERAS”。由于很少有高质量的随机临床试验 （RCT） 来评估个体术前、术中和术后要素的具体作用，因此确定基本的 ERAS 要素以促进更广泛的实施仍面临挑战。为了实现这一目标，需要解决大型 RCT 和较小的详细假设生成观察性研究之间的平衡，以增强知识并限制研究资源的浪费。