# Enhanced Recovery After Surgery Protocols in Pediatric Surgery: A Narrative Review of Current Evidence

## TL;DR

This review summarizes how Enhanced Recovery After Surgery (ERAS) protocols can improve outcomes in pediatric surgery, though challenges remain in adapting them for all age groups.

## Contribution

The paper provides a critical evaluation of current evidence on ERAS protocols in pediatric surgery, highlighting gaps and future directions.

## Key findings

- ERAS protocols in pediatric surgery are linked to shorter hospital stays and better postoperative outcomes.
- Most evidence supports ERAS in colorectal, abdominal, and urologic surgeries, but data for neonates and infants is limited.
- Implementation challenges include standardization and multidisciplinary team adherence.

## Abstract

Enhanced Recovery After Surgery (ERAS) protocols have been successfully implemented in adult surgical practice, demonstrating reductions in postoperative complications, the length of hospital stay, and healthcare costs. In pediatric surgery, however, the adoption of ERAS principles has progressed more slowly due to age-related physiological variability, the heterogeneity of surgical procedures, and the limited availability of high-quality evidence in certain pediatric populations.

This narrative review aims to summarize and critically evaluate the current evidence on the implementation of ERAS protocols in pediatric surgery, with a focus on core principles, clinical outcomes, implementation challenges, and future directions. A narrative review of the literature was conducted using PubMed and Scopus databases. Articles published between 2010 and 2025 were identified using keywords related to enhanced recovery, pediatric surgery, and perioperative care. Original studies, reviews, and clinical guidelines involving pediatric surgical patients were included, while studies exclusively involving adult populations, editorials, and conference abstracts without full text were excluded.

Available evidence suggests that the implementation of ERAS protocols in pediatric surgery is associated with shorter hospital stays, improved postoperative pain control, the earlier resumption of oral intake and mobilization, and high levels of patient and family satisfaction, without an increase in postoperative complications. Most of the published evidence originates from pediatric colorectal, abdominal, and urologic surgeries. However, challenges remain regarding protocol standardization, multidisciplinary team adherence, and the adaptation of ERAS pathways to different age groups, particularly neonates and infants.

ERAS protocols represent a promising strategy for optimizing perioperative care in pediatric surgery. Although current evidence supports their safety and effectiveness in selected procedures, further prospective and multicenter studies are needed to develop age-specific protocols and expand ERAS implementation across pediatric surgical subspecialties.