Enhanced Recovery After Surgery (ERAS) Pathways in Tertiary Hospitals: Effects on Post-operative Opioid Use and Length of Stay

Abstract

Background:
Enhanced Recovery After Surgery (ERAS) pathways attenuate surgical stress, accelerate convalescence and curb opioid exposure, yet their impact within tertiary hospitals, where comorbidity and baseline opioid use are greatest, remains unclear.
Methods:
PubMed, EMBASE, Scopus and CENTRAL were searched from inception to 31 May 2024. Randomised trials and cohort studies reporting postoperative opioid consumption and/or hospital length of stay (LOS) in adults treated in tertiary or teaching hospitals were eligible. Two reviewers performed duplicate screening, data extraction and risk-of-bias appraisal (RoB 2, ROBINS-I).
Results:
Of 2 148 records, nine studies met inclusion criteria (three trials, six cohorts; 56 004 patients). ERAS protocols incorporated multimodal analgesia, early mobilisation and accelerated feeding. Median inpatient opioid use fell by 40–54 % in trials and by 41–47 % in cohorts; a claims-based analysis showed the 180-day opioid-fill rate declined from 31.3 % to 20.9 % (rate ratio 0.53). LOS decreased by a pooled mean 1.7 days (range 0.8–3.5). No study reported higher Clavien–Dindo grade III–V complications or 30-day readmissions.
Conclusions:
ERAS pathways in tertiary hospitals consistently reduce opioid dependence and shorten LOS without compromising safety, delivering measurable fiscal and patient-centred gains. Wider adoption with rigorous compliance auditing and harmonised outcome reporting is warranted, particularly in under-represented regions and complex surgical populations. Future multicentre trials should also explore protocol adaptations for frail elderly and resource-limited settings.