OBJECTIVE:To explore the effects of a prior history of arthroscopic surgery on the risk of postoperative infection following knee, hip and shoulder arthroplasty. METHODS:Searched relevant literature from four major English databases up to August 10, 2025. A total of 31 observational studies were included. The generalized linear mixed model was used to pool effect sizes and calculate the odds ratios (OR) for postoperative infection after joint arthroplasty. Subgroup analyses stratified by joint type were performed, and the pooled incidence rates of infection were synthesized. RESULTS:A prior arthroscopic surgery significantly increased the risks of overall infection (OR = 1.33, 95%CI: 1.14-1.56) and deep infection (OR = 1.38, 95%CI: 1.17-1.63) after joint arthroplasty, with obvious heterogeneity among different joints. A history of knee arthroscopy was associated with elevated postoperative infection risks, and prior shoulder arthroscopy markedly increased the risk of deep infection. No significant correlation was observed between hip arthroscopy and infection risk. The pooled overall and deep postoperative infection rates were both 2% in this population. CONCLUSION:Clinicians should attach importance to this joint-specific risk when formulating treatment plans. Further studies focusing on the shoulder joint are required to validate the present findings.
Introduction Postoperative seroma remains a frequent complication following breast cancer surgery in both sexes. Despite continuous surgical advancements, its incidence widely ranges from 3% to 85%, significantly affecting the postoperative course, extending hospitalization duration, and diminishing patients’ quality of life.Aims and objectives The primary objective of this narrative review is to evaluate current preventive and therapeutic approaches for postoperative seromas, analyzing the efficacy of surgical techniques, dead space closure, and drainage optimization protocols.Methods This article provides a comprehensive review of current concepts regarding the complex pathogenesis, multifactorial risk structure, and management approaches for postoperative seromas. The study systematically examines preventive possibilities, evaluating the efficacy of modern surgical instruments, dead space closure techniques, and drainage optimization protocols.Results Seroma formation results from a combination of localized inflammatory responses and mechanical lymphatic trauma. Preventive measures such as fibrin sealants, early drain removal, and flap fixation demonstrate varying efficacy. Standard management primarily involves repeated aspiration punctures and the active prevention of secondary infections.Discussion No single method is universally effective; therefore, seroma prevention must be comprehensive and individualized, factoring in the specific surgical strategy, tissue healing characteristics, and the patient’s somatic status.
BACKGROUND:Acute perioperative handgrip strength change measured at discharge (Δacute) is often interpreted as a marker of vulnerability. However, it is discharge-anchored, influenced by peri-discharge conditions, and not measured at a standardized postoperative timepoint. We examined whether Δacute was independently associated with prolonged length of stay (LOS) after elective abdominal surgery once baseline physiological reserve was considered. METHODS:Adults undergoing elective abdominal surgery were prospectively enrolled in a multicenter observational cohort. Handgrip strength (HGS) was assessed at admission and discharge, and frailty using the Fried phenotype. Δacute was defined as discharge minus admission HGS. The primary outcome was LOS >10 days. Associations were examined using correlation and multivariable logistic regression, with sensitivity analyses addressing extreme values and non-normal distributions. RESULTS:Among 223 patients (median age, 65 years), 48 (21.5%) had prolonged LOS. Frailty status (OR 2.63, 95% CI 1.47-4.70) and oncologic surgery were independently associated with prolonged LOS, whereas admission HGS was not significant after adjustment. Δacute showed substantial interindividual variability, correlated inversely with admission HGS (r = -0.325, p < 0.001), and differed by surgical context, but was not associated with prolonged LOS in univariable or multivariable analyses. CONCLUSIONS:Discharge-anchored Δacute was not independently associated with prolonged LOS after accounting for baseline reserve and surgical context. Because both Δacute and LOS may be influenced by discharge timing and institutional practices, these findings do not establish that acute strength change reflects postoperative perturbation rather than intrinsic vulnerability.
BACKGROUND:Immediate extubation after heart transplantation (IEAHT) may enhance postoperative recovery. However, factors associated with IEAHT and the impact of opioid exposure remain unknown. Building upon our favorable IEAHT experiences in a pediatric patient, we now examine the use of IEAHT in adult patients. METHODS:This small, retrospective, exploratory case-control study (August 2018-March 2025) included 8 patients extubated in the operating room (case group) matched 1:3 to 24 patients extubated in the ICU (control group). Demographic data, operative characteristics, anesthetic techniques, and postoperative outcomes were collected and compared between the two groups. RESULTS:Remifentanil-based TIVA was used more frequently in the case group (8/8, 100% vs. 6/24, 25%; p = 0.001). The case group had shorter cardiopulmonary bypass (median 105 vs. 155 min, p = 0.004) and operative times (249 vs. 329 min, p = 0.012). Among patients receiving remifentanil‑based TIVA, total opioid consumption did not differ between groups (p = 0.852). No significant inter-group differences were observed in postoperative complications or lengths of stay. CONCLUSION:In this exploratory cohort, remifentanil-based TIVA was associated with operating room extubation. Remifentanil-based TIVA may be feasible in selected patients, but its safety and efficacy require confirmation in adequately powered prospective randomized trials.
OBJECTIVE:This study compared radiographic spinopelvic alignment parameters and clinical outcomes after multisegment posterior lumbar interbody fusion (PLIF) with different degrees of sagittal correction in multilevel degenerative lumbar spine disease. METHODS:We retrospectively reviewed adults who underwent three-segment PLIF (L2-L5 or L3-S1) between January 2020 and August 2021. Patients were stratified post hoc by achieved change in fused-segment lordosis (ΔSL) from preoperative to early postoperative radiographs (ΔSL ≤5° vs >5°). Spinopelvic parameters (SL, lumbar lordosis [LL], pelvic tilt [PT], sacral slope [SS], pelvic incidence [PI], PI-LL) and patient-reported outcomes (Visual Analog Scale [VAS], Oswestry Disability Index [ODI]) were assessed preoperatively and at follow-up (≥2 years). RESULTS:A total of 157 patients were included (Group A, n = 85; Group B, n = 72) with comparable baseline parameters. At 1 month and 1 year, SL was higher in Group B. At final follow-up, Group B showed more favorable alignment (higher SL/LL and lower PT/PI-LL) and better VAS/ODI than Group A (all p < 0.05). Postoperative complications were similar, except for a higher ileus rate in Group B (p = 0.024). CONCLUSIONS:A larger achieved ΔSL was associated with improved mid-to long-term spinopelvic alignment parameters and better final follow-up patient-reported outcomes. This potential benefit may occur at the expense of worse early postoperative symptoms; prospective studies with predefined correction targets are warranted.
Background Seroma is one of the most common postoperative complications following hernia repair. This study evaluated whether the local application of Pseudomonas aeruginosa injection (PA-MSHA) could reduce the duration of seroma and promote healing of the graft and surrounding tissues after abdominal wall incisional hernia repair.Methods 56 Sprague-Dawley rats were used to assess the efficacy and optimal dosage of PA-MSHA in reducing seroma formation after latissimus dorsi resection. 54 rats underwent abdominal wall hernia repair and were randomly assigned to three groups: sham, saline, or PA-MSHA. Seroma formation was monitored, and tissue samples were collected for histological and immunohistochemical analyses.Results Among five groups, the medium-dose group (0.1 mL/kg) demonstrated the most significant reduction in seroma volume. PA-MSHA significantly shortened the duration of seroma and enhanced both early and mid-term tissue healing. Sirius Red staining indicated a significantly higher collagen type I/III ratio on days 7 and 14. Immunohistochemical analysis demonstrated elevated expression of CD68 and CD31 during the early healing phase in the PA-MSHA group. By day 28, graft shrinkage did not differ significantly among the groups.Conclusions Intraoperative local administration of PA-MSHA effectively reduced seroma persistence and enhanced early tissue regeneration and abdominal wall integrity without triggering excessive foreign body reactions or adverse events.
Purpose To evaluate the reduction in ablated lesion volume after ultrasound-guided percutaneous radiofrequency ablation (RFA) for benign breast tumors and identify factors associated with shrinkage.Methods This retrospective study included 64 patients (244 benign breast tumors) treated with RFA from December 2014 to February 2021. All tumors were biopsy confirmed before ablation. Follow-up at 1, 3, 6, and 12 months measured nodule volume changes and recorded complications, with analyses at the individual nodule level.Results All patients were discharged within 24h without major events. Grade I pain occurred in two patients (3.13%), with no higher-grade complications observed. The complete ablation rate at 1 month was 98.77% (241/244). At 12 months, lesion volume decreased significantly (p < 0.001), with a mean volume reduction ratio (VRR) of 97.14% and a complete sonographic disappearance rate of 81.97% (200/244). Multiple mixed-effect linear regression showed that lesions with a maximum diameter > 20 mm and an absence of blood vessels within 5 mm of the nodule were significantly associated with a lower 12-month VRR.Conclusions Ultrasound-guided RFA is safe and effective for benign breast tumors. Ablated lesions effectively shrink, with nodule size and the presence of blood vessels around the nodules being associated with the 12-month VRR.
BACKGROUND:As a typical complication, postoperative nausea and vomiting (PONV) usually occurs among patients undergoing general anesthesia surgery, diminishing postoperative satisfaction and recovery. OBJECTIVE:Herein, we applied a new G-protein-biased μ-opioid receptor agonist, oliceridine, to compare its management with fentanyl on PONV among high-risk patients receiving general anesthesia with transversus abdominis plane block (TAP). METHODS:In this prospective, double-blind, randomized controlled study, a total of 280 patients were enrolled for general anesthesia surgery, including laparoscopic cholecystectomy and laparoscopic gynecological surgery. Participants were randomly divided into either the oliceridine group or the fentanyl group at a 1: 1 ratio. Afterwards, the primary outcome was the rate of nausea and vomiting on postoperative day 2. The secondary outcomes comprised the visual analogue scale (VAS) score of PONV, intraoperative analgesic effect, rescue antiemetic treatment, hemodynamic parameters during T1-T5, postoperative pain assessment, hospitalization period, gut function, time of drink and food intake, drainage tube removal, hospitalizations, and perioperative complications. RESULTS:Among the enrolled 279 patients, oliceridine effectively reduced the occurrence of nausea (26.4% versus 12.9%, p = 0.005) and vomiting (24.3% versus 6.5%, p < 0.001). In addition, the postoperative nausea VAS score showed significantly lower in the oliceridine group compared with the fentanyl group (1.40 ± 1.31 versus 2.01 ± 1.79, p = 0.013), accompanied by reduced rescue antiemetic rate (17.1% versus 7.2%, p = 0.011), with stable hemodynamic condition and comparable postoperative recovery. DISCUSSION:According to our study, oliceridine may be a viable substitute for general anesthesia to ameliorate postoperative incidence of PONV, along with its impressive pain control during anesthesia induction and maintenance. CLINICAL TRIAL REGISTRATION:Chinese Clinical Trial Registry (ChiCTR2400089121).
OBJECTIVE:Metastatic melanoma has a poor prognosis. This study aimed to develop and validate era-specific nomograms for Stage IV (M1a-c) melanoma and assess the survival impact of surgery across two eras. METHODS:This retrospective Surveillance, Epidemiology, and End Results (SEER) study included 3,319 stage IV melanoma patients divided into pre-immunotherapy era (2001-2005, n = 622) and early immunotherapy era (2011-2015, n = 2,697) cohorts. Cox regression identified overall survival (OS) prognostic factors. Era-specific nomograms predicting 1-, 3-, and 5-year OS were constructed and validated. The survival benefit of surgery was assessed using Kaplan-Meier analysis. RESULTS:Age, M-stage, lactate dehydrogenase, chemotherapy, and surgery were consistent independent prognostic factors in both eras. The nomograms showed good calibration yet limited discriminatory capacity only slightly exceeding the 0.5 random threshold (C-index: 0.649 and 0.641 for pre- and early immunotherapy eras, respectively). Surgery showed longer OS in patients of the overall immunotherapy cohort: median OS was 17 vs. 6 months for surgical vs. non-surgical patients (p < 0.001). The benefit was pronounced in the M1a (40.5 vs. 20.0 months, p < 0.001) and M1c (11 vs. 5 months, p < 0.001) subgroups. Patients in the early immunotherapy era had longer OS (8 vs. 6 months, p < 0.001). CONCLUSIONS:We constructed population-based era-specific nomograms for stage IV melanoma. Within the immunotherapy cohort, surgery correlates with prolonged survival, suggesting surgical evaluation for selected metastatic melanoma patients.
PURPOSE:Atypical meningiomas have higher recurrence and mortality than benign variants, and age may influence treatment decisions and outcomes. We evaluated associations between age, treatment modality, and survival in patients with atypical meningioma. METHODS:Adults with histologically confirmed intracranial atypical meningioma were identified from the 2000-2021 Surveillance, Epidemiology, and End Results database. Multivariable Cox regression assessed overall survival (OS) and cancer-specific survival (CSS), and logistic regression evaluated predictors of gross total resection (GTR) versus subtotal resection (STR). RESULTS:Among 3,882 patients, advanced age was associated with worse OS and CSS. Compared with patients aged <40 years, those aged ≥60 years had higher overall mortality (aHR 5.29, 95% CI 3.78-7.39) and cancer-specific mortality (aHR 3.15, 95% CI 1.99-4.99; both p < 0.001). Patients aged 40-59 years showed intermediate OS risk but no significant difference in CSS. Older patients received radiotherapy less often, whereas age was not an independent predictor of GTR. STR, male sex, unmarried status, tumor ≥5 cm, and Black race were associated with poorer survival. CONCLUSION:Advanced age independently predicted inferior OS and CSS but not a lower likelihood of GTR, supporting individualized, age-sensitive management.
OBJECTIVE:This study evaluated whether moxibustion at the Dazhui point (GV14) reduces intraoperative hypothermia during cesarean delivery under spinal anesthesia. METHODS:Sixty - four parturients (32/group) scheduled for cesarean section were randomly assigned 30 min before surgery to receive either moxibustion at Dazhui or sham moxibustion (pre-combusted cooled moxa pack); both groups received standard blanket warming. The primary outcome was hypothermia incidence (core temperature <36.0 °C). Secondary outcomes included shivering, thermal comfort (0-100 scale), Apgar scores, hospital stay, and postoperative complications (fever, blood loss, infection). RESULTS:Baseline characteristics were similar between groups. Hypothermia incidence was significantly lower in the intervention group (62.50%) than in the sham group (84.38%; p = 0.048). From 10 min after surgery start until operating room departure, core temperature remained consistently higher in the moxibustion group (p < 0.05). Shivering occurred less often in the intervention group (43.75% vs. 68.75%, p < 0.05). Thermal comfort scores were higher in the intervention group (87.19 ± 9.24 vs. 78.75 ± 10.08, p < 0.05). No significant differences were found in Apgar scores, hospital stay, or postoperative complications. CONCLUSION:Preoperative moxibustion at Dazhui reduces intraoperative hypothermia and improves maternal comfort during cesarean delivery without adverse neonatal effects. Although it cannot completely eliminate hypothermia or shivering, it may serve as an effective non - pharmacological adjunct for thermoregulation in obstetric anesthesia.
The incidence of early-onset colorectal cancer (EOCRC) is increasing worldwide, and CRC survivors may have an elevated risk of second primary cancer (SPC). This retrospective study analyzed 13,302 CRC patients diagnosed between 2008 and 2018 at a Chinese high-volume cancer center, including 635 (4.77%) who developed SPC after CRC. Patients were stratified by age at CRC diagnosis (<50, 50-69, and ≥70 years) to identify risk factors, cancer types, and prognostic significance of SPC. Multivariable Cox analysis showed that older age, neoadjuvant therapy, tumor location, T stage, N stage, M stage, and radiotherapy were independently associated with SPC in the overall cohort. Age-stratified analyses revealed heterogeneous associated factors, with radiotherapy being the only independent factor in the ≥70-year group. Five-year overall survival was comparable between the <50- and 50-69-year groups and was significantly better than in the ≥70-year group among all CRC patients and those with SPC. Early-stage patients with SPC had better overall survival than those without SPC, whereas advanced-stage patients without SPC had better survival. These findings suggest age-specific heterogeneity in SPC development and support tailored surveillance strategies after CRC.
OBJECTIVE:This study aimed to investigate the incidence, causes, and risk factors of intensive care unit (ICU) admission in patients undergoing laparoscopic repair of perforated peptic ulcer (PPU) with enhanced recovery after surgery (ERAS) implementation. METHODS:A retrospective cohort study included 342 patients undergoing laparoscopic PPU repair with ERAS protocols. Univariable and multivariable logistic regression were used to identify independent risk factors for ICU admission. RESULTS:Of 279 included patients, 76 (27.2%) required ICU admission. The causes of admission were respiratory failure (44.7%), circulatory failure (23.7%), surgical complications (10.5%) and others (21.1%). Multivariable analysis revealed that age ≥ 65 years (odds ratio [OR] = 3.63, p = 0.002), ASA physical status III-IV (OR = 3.70, p = 0.002), heart failure (OR = 12.86, p = 0.008), COPD (OR = 16.28, p = 0.003), and kidney failure (OR = 9.42, p = 0.004) were independent risk factors for ICU admission. CONCLUSIONS:In the context of ERAS protocol implementation, the incidence of ICU admission following laparoscopic repair of PPU was 27.2%, accompanied by a 30-day ICU mortality rate of 6.6%. Among the causes of ICU admission, respiratory failure emerged as the leading factor.
Objective This study compared the effects of transumbilical single‑port laparoscopic myomectomy (SPLM) and multi‑port laparoscopic myomectomy (MPLM) on stress response, immune function, and incision cosmetic outcomes in patients with uterine fibroids (UFs).Methods A total of 146 UF patients were randomized to receive SPLM (n = 73) or MPLM (n = 73). Outcome measures included perioperative indicators, stress markers, immune parameters, ovarian function, incision cosmetic outcomes, postoperative complication rate, menstrual normalization, and recurrence.Results The SPLM group had longer operative time and shorter postoperative exhaustion and hospitalization than the MPLM group (P < 0.05). At 3 days postoperatively, the SPLM group showed higher SOD, CD3+, and CD4+/CD8+ levels and lower MDA and ROS levels than the MPLM group (P < 0.05). At 3 months postoperatively, no significant differences were observed in AMH, LH, or FSH levels between the two groups (P > 0.05). The SPLM group showed higher CS scores and lower BIS scores compared with the MPLM group (P < 0.05). The rates of complications, menstrual recovery, and recurrence were comparable (P > 0.05).Conclusion Compared with MPLM, SPLM showed better effects in reducing oxidative stress, maintaining immune function, and improving incision cosmetic outcomes for patients with UFs.
BACKGROUND AND OBJECTIVE:This study compared the efficacy and safety of En-Bloc and standard techniques in laser enucleation, providing an evidence-based basis for surgical decision-making in the management of benign prostatic obstruction (BPO). METHODS:Relevant studies were systematically identified through searches of PubMed, Embase, Web of Science, and Cochrane Library databases up to May 2025. Data analysis was performed using RevMan 5.4. RESULTS:Data from 15 studies containing 9,397 participants were reviewed. The En-Bloc technique was associated with a reduction in enucleation time (mean difference [MD] - 8.43, 95% CI -13.0 to -3.91, p < 0.001), an increase in enucleation efficiency (MD 0.21, 95% CI 0.07 to 0.36, p = 0.004), a decrease in operative time (MD -4.70, 95% CI -8.81 to -0.60, p = 0.02), and a lower rate of major complications (odds ratio 0.62, 95% CI 0.42-0.90, p = 0.01) than the standard technique. No significant differences in postoperative short-term functional outcomes were found. CONCLUSIONS:The updated evidence suggests that the En-Bloc technique is associated with improved perioperative performance and a lower rate of major complications compared to the conventional approach, while preserving comparable functional outcomes. These findings suggest potential clinical benefits of En-Bloc enucleation in the surgical management of BPO.
Introduction Perioperative acute pain remains a major challenge because conventional analgesic strategies are often limited by inadequate efficacy and opioid-related adverse effects. Ultrasound-guided fascial plane blocks (FPBs) have become important components of multimodal analgesia. This review summarizes the mechanisms, clinical efficacy, safety, and future directions of major FPBs, including transversus abdominis plane, quadratus lumborum, and serratus anterior plane blocks, and discusses the emerging role of artificial intelligence (AI).Methods PubMed, Embase, and the Cochrane Library were searched for relevant studies published up to December 2023. Clinical trials, meta-analyses, and mechanistic studies were reviewed, with emphasis on analgesic efficacy, opioid-sparing effects, safety, and AI-assisted applications.Results Current evidence indicates that ultrasound-guided FPBs provide effective truncal analgesia, reduce postoperative pain and opioid consumption, and may improve recovery while maintaining favorable safety profiles in selected settings. However, clinical benefits vary according to block type, surgical procedure, and comparator regimen. Adjuvants and continuous catheter techniques may prolong analgesia, whereas AI-assisted systems show promise for image interpretation and training.Conclusion Ultrasound-guided FPBs are valuable components of perioperative multimodal analgesia and may improve analgesic quality while reducing opioid requirements.
BACKGROUND:Many studies have reported preoperative predictors of overall survival (OS) of patients undergoing liver resection (LR) for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC); however, their results are inconsistent. METHODS:We included 170 patients with BCLC stage B undergoing LR during 2011-2021. RESULTS:Multivariate analysis showed that alpha-fetoprotein (AFP) >50 ng/ml (hazard ratio [HR] = 1.959; 95% confidence interval [CI] = 1.156-3.319; p = 0.012), undergoing major resection (HR = 2.514; 95% CI = 1.225-5.161; p = 0.012), and indocyanine green retention rate at 15 min ≥10% (HR = 1.777; 95% CI = 1.038-3.040; p = 0.036) were associated with overall mortality. We constructed a predictive model with these variables. The model provided three risk strata for 5-year OS, low risk, medium risk, and high risk, with 5-year OS of 58%, 30%, and 12%, respectively (p < 0.001). The c-index of this model was 64.7%. The calibration plots showed overall high agreement between model predictions and observed outcomes. CONCLUSIONS:The risk prediction model we developed to predict the OS of patients undergoing LR for BCLC stage B HCC is helpful for treatment decision-making.
OBJECTIVE:To evaluate short-term clinical outcomes, surgeon-reported fatigue, and staff user experience associated with a multifunctional operative support arm in reproductive laparoscopic surgery. DESIGN:Single-center, parallel-group randomized controlled trial. SETTING:Tertiary university-affiliated reproductive medicine center. PATIENTS:One hundred women aged 25-40 years undergoing laparoscopic surgery for stage I pelvic endometriosis, hydrosalpinx, or benign ovarian cysts. INTERVENTIONS:Participants were randomized to surgery using the multifunctional operative support arm or a conventional passive support condition. MAIN OUTCOME MEASURES:The primary outcome was surgeon-reported fatigue assessed using a 0-10 visual analog scale. Secondary outcomes included staff satisfaction and device-related comfort. Clinical outcomes included operative duration, postoperative infection, length of stay, anti-Müllerian hormone, and antral follicle count. RESULTS:Baseline characteristics were comparable between groups. Operative duration, length of stay, postoperative infection, and ovarian reserve indicators did not differ significantly. Mixed-effects analysis of 550 surgeon and 450 nurse evaluations showed lower surgeon fatigue with the device than with conventional support (-0.66, 95% CI -0.78 to -0.54; p < 0.001). Ventilation, temperature control, and comfort scores were also higher, although satisfaction differences were small. CONCLUSION:The device improved staff-reported ergonomic comfort without adverse short-term clinical effects, but confirmation with objective measures is needed.
Background Postoperative pancreatic fistula (POPF) is recognized as the main cause of postpancreatectomy hemorrhage (PPH). This study investigated the correlation between POPF and PPH after pancreatoduodenectomy (PD).Methods We retrospectively analyzed PDs at our center from January 2005 to December 2023. We documented patient characteristics, surgical factors, and outcomes and did a multivariate analysis of PPH.Results Among 659 PD patients, the overall PPH incidence was 9.3% (n = 62), with 85.5% having late PPH. The PPH group had higher POPF rates, especially Grade B/C POPF. The PPH group also had higher postoperative pancreatic fluid accumulation on day 5 and a higher incidence of sustained peak amylase levels in the drainage fluid. Multivariate analysis showed intraoperative blood loss >1,000 mL, clinically relevant - POPF, and postoperative intra - abdominal infection as independent risk factors for late PPH.Conclusion Grade B/C POPF, significant intraoperative blood loss, and postoperative intra - abdominal infection are independently associated with late PPH. POPF may not be the only cause of PPH. Our findings suggest impaired pancreatic drainage may contribute to PPH, but this needs prospective validation.
The concept of Enhanced Recovery After Surgery (ERAS) was introduced 30 years ago and has since evolved substantially. Advances in ERAS have significantly improved clinical outcomes and the quality of perioperative care for surgical patients. To mark the 30th anniversary of ERAS, this review summarizes its historical development, current state, and future directions, with the aim of informing continued progress in ERAS practice. The authors conclude that the era of ERAS Medicine is coming.
