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Ann Clin Nutr Metab 2024;16(1):1-2
Published online April 1, 2024
A comprehensive overview of enhanced recovery after surgery
Sang Hyun Shin

Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Sang Hyun Shin, email: surgeonssh@skku.edu
Received March 6, 2024; Revised March 6, 2024; Accepted March 6, 2024.
© 2024 The Korean Society of Surgical Metabolism and Nutrition and The Korean Society for Parenteral and Enteral Nutrition.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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In the 1990s and 2000s, there were many advances in surgical techniques and perioperative management in various surgeries. Based on these advances, a group of European academic surgeons developed an enhanced recovery pathway [1,2], and the enhanced recovery after surgery (ERAS) study group was launched in London in 2001. The ERAS has revolutionized perioperative care by adopting a multidisciplinary approach aimed at optimizing patient outcomes, reducing complications, and improving postoperative recovery. The paradigm shift introduced by ERAS had transformed perioperative care in surgery. Since the introduction of the first guideline for colorectal surgery in 2005 [3], the protocol has been expanded to include various organs and surgeries and has been revised based on various evidence. The latest guidelines are available through the ERAS® Society webpage (https://erassociety.org). This editorial introduces the key components of the ERAS and emphasizes the importance of nutrition and metabolism in perioperative management. The key components of ERAS are as follows:

1. Preoperative optimization: Patient education has emerged as a pivotal component of ERAS, and evidence suggests that informed patients experience reduced anxiety and exhibit better compliance with ERAS protocols [4]. Nutritional optimization is another crucial aspect, with preoperative nutritional assessment and supplementation playing a significant role in enhancing the patient’s immune response and relieving surgical stress [5,6].

2. Minimally invasive techniques: These approaches minimize tissue trauma, reduce hospital stays, and expedite recovery.

3. Multimodal analgesia: Regional anesthesia, non-opioid medications, and patient-controlled analgesia collectively aim to alleviate pain while minimizing opioid-related adverse effects, fostering enhanced patient comfort.

4. Early mobilization and ambulation: The ERAS emphasizes the importance of early postoperative mobility, and encouraging patients to ambulate shortly after surgery has been linked to improved pulmonary function and faster recovery of bowel function.

5. Individualized fluid management: Tailored fluid administration to individual patients prevents complications associated with fluid overload or depletion, contributing to optimized tissue perfusion.

6. Postoperative nutrition and diet: Early initiation of oral intake and nutritional support promote faster recovery and reduce the length of hospital stays [7].

As seen in the key components above, ERAS emphasizes not only surgical techniques, but also a multidisciplinary approach such as nutritional support and patient metabolism. Therefore, a multidisciplinary team consisting of surgeons, anesthesiologists, and nutrition experts is an important factor in patient recovery after surgery. The Annals of Clinical Nutrition and Metabolism, collaboratively published by The Korean Society of Surgical Metabolism and Nutrition and The Korean Society for Parenteral and Enteral Nutrition, will facilitate multidisciplinary treatment of surgical patients.

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  5. Rinninella E, Persiani R, D'Ugo D, Pennestrì F, Cicchetti A, Di Brino E, et al. NutriCatt protocol in the enhanced recovery after surgery (ERAS) program for colorectal surgery: the nutritional support improves clinical and cost-effectiveness outcomes. Nutrition 2018;50:74-81.
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  6. Ardito F, Lai Q, Rinninella E, Mimmo A, Vellone M, Panettieri E, et al. The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol. Updates Surg 2020;72:681-91.
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  7. Tweed T, van Eijden Y, Tegels J, Brenkman H, Ruurda J, van Hillegersberg R, et al. Safety and efficacy of early oral feeding for enhanced recovery following gastrectomy for gastric cancer: a systematic review. Surg Oncol 2019;28:88-95.
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