Enhanced Recovery After Surgery (ERAS) in Latin America and the Caribbean: A Scoping Review of Implementation Strategies, Clinical Outcomes, and Health System Impact.

Abstract

Enhanced Recovery After Surgery (ERAS) programs are increasingly recognized as effective pathways to improve perioperative outcomes, yet their implementation across Latin America and the Caribbean remains poorly mapped. Understanding current strategies, clinical results, and economic implications is essential to identify regional gaps and guide evidence-based surgical improvement. This scoping review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR reporting guidelines. Searches were conducted in MEDLINE/PubMed, Web of Science, LILACS, and CENTRAL, complemented by gray literature and reference screening. Eligible studies were investigations evaluating perioperative optimization interventions in any surgical population within Latin America and the Caribbean. Data extraction included study characteristics, ERAS components, implementation strategies, clinical outcomes, and economic impact. Forty-five studies published between 2006 and 2025 were included, predominantly from Brazil (n = 28), Mexico (n = 9), Argentina (n = 4), and Chile (n = 3). Most studies implemented multimodal perioperative pathways, with the most frequent ERAS strategies being preoperative fasting abbreviation (n = 26), early refeeding (n = 22), early mobilization (n = 22), opioid-sparing anesthesia (n = 19), preoperative education (n = 16), and restrictive intravenous fluids (n = 16). Clinical outcomes consistently demonstrated reductions in postoperative length of stay and complications. Only five studies reported economic data, all focused on hospital-level costs, showing decreased expenditures primarily driven by shorter hospitalization. ERAS initiatives are increasing across Latin America and the Caribbean, with evidence suggesting reductions in hospital stay and costs. Nevertheless, adoption remains uneven and concentrated in a few countries. Expanding implementation will require addressing structural disparities and generating stronger economic and implementation-focused evidence to support broader regional uptake.