Eras protocol in cardiac surgery. Umbrella review of systematic reviews

Abstract

Introduction: Enhanced Recovery After Surgery (ERAS) protocols represent a multimodal perioperative approach designed to reduce surgical stress, minimize postoperative complications, and accelerate recovery in patients undergoing cardiac surgery. Objective: To analyze the scientific evidence regarding the effectiveness of ERAS protocols on perioperative outcomes in cardiac surgery. Methods: A literature review was conducted using the PubMed database. The search strategy included the descriptors “cardiac surgery” and “ERAS protocol”, combined with the Boolean operator AND. Systematic reviews published between January 2021 and April 2026, involving adult patients undergoing cardiac surgery, were included. Results: Twenty-one studies were identified, of which eight systematic reviews met the eligibility criteria, comprising a total of 48,248 patients. The evidence demonstrated that ERAS protocols were associated with shorter mechanical ventilation time, reduced intensive care unit and hospital length of stay, fewer perioperative complications, and improved postoperative recovery. Multimodal analgesia and multidisciplinary care were identified as key components of successful ERAS implementation. Conclusion: ERAS protocols have shown the potential to improve perioperative recovery in cardiac surgery by reducing mechanical ventilation time, intensive care unit and hospital stay without increasing mortality. However, the heterogeneity of existing protocols and the low certainty of the available evidence highlight the need for well-designed multicenter randomized controlled trials to standardize their implementation and confirm their clinical benefits.