Enhanced recovery after surgery programs: Applying knowledge from the Covid-19 era to enhance rural surgery

Introduction: Enhanced Recovery After Surgery (ERAS) is a perioperative protocol proven to improve post-operative outcomes and reduce hospital length-of-stay. It has been implemented in both metropolitan and rural healthcare sites, with variable successful rates.
Objective: In this review, we explore the evolution of the ERAS protocol and the unique challenges to its implementation within rural and regional settings: with a particular focus on the seismic impacts of the COVID-19 pandemic. We aim to identify current pitfalls in ERAS compliance, and lessons that can be learned and applied to rural clinical practice.
Design: We conducted a systemized search of published literature regarding the impact of COVID-19 on ERAS pathways around the world in rural and metropolitan healthcare centres.
Findings: Six observational studies and seven commentaries were included in this review.
Discussion: The Covid 19 pandemic influenced elements of ERAS program both positively and negatively on the health care globally. There was an exponential uptake of technology and remote platforms during pandemic as a way to reduce transmission of COVID-19.
Conclusion: The Covid-19 pandemic introduced an innovative approach to healthcare delivery. Novel approaches with inbuilt technological solutions should be applied to ERAS pathways, improving their versatility and expanding their reach to a wider patient community.