Enhanced recovery after surgery: past, present and future

In the 1990’s the average length of hospital stay for patients undergoing colonic surgery across Europe and North America was routinely greater than 10 days. Surgery was almost exclusively via an open approach and in addition the established wisdom with regards to perioperative care included recommending prolonged starvation times, bed rest, copious IV fluids, opiate-based analgesia and the routine use of surgical drains, nasogastric tubes and bowel preparation. Postoperative morbidity was high with ileus, sepsis, venous thromboembolism and anastomotic leak all relatively commonplace.