I was pleased to be invited to write an editorial on ERAS (Enhanced Recovery After Surgery), a topic that has been extensively covered in the issue 113 (2) of the current year.

This issue of the Journal has 6 papers on optimized recovery, demonstrating the relevance that such programs have achieved worldwide, and the importance Argentina gives to the matter^1-6. The ERAS Society endorses what has been stated above and nowadays sets the standards for this multimodal approach system through its recommendations⁷.

Ljunqvist² stated that, even though such recommendations exist, several groups with different protocols obtain similar results; this is probably due to the fact that most of the protocols used have few differences between them. Probably, the differences are due to the environments (public vs. private hospital) and, in agreement with Edmonton, beyond the economic resources, resistance to change and the development of new capabilities may turn out to be difficulties to overcome in the continuous improvement of these programs⁴. For Lillemoe⁸, educating the patient and family, pain management and fluid therapy are the cornerstones to construct an enhanced recovery program.

Most publications on surgeries in different organs basically show a decrease in length of hospital stay, a probable decrease in the number and severity of complications, and a lower number of readmissions. The same conclusions were reached for colorectal surgery by the group of Hospital Italiano⁶ and of the U.K.⁵. This last group emphasizes prehabilitation; we fully agree that -basically in cancer patients- optimizing anemia, nutritional status and comorbidities is essential to increase the success of each program. Mentz et al.⁶. reported that adherence to all the items of the programs used reduces the number of length of hospital stay; >60% of adherence results in a reduction of 1.77 days in length of hospital stay when compared to patients managed with standard care. When adherence is > 70%, this reduction is even greater. Another important issue is the percentage of patients who achieve full recovery at discharge because it is associated with the number of readmissions and probably the long-term outcomes.

Finally, as Bisch et al.⁴ stated, the aim of implementing an ERAS program is to reduce costs for patients by approximately CAD 1798 for each service provided. For this reason, and because it increases the productivity of the institutions (the decrease in length of hospital stay promotes an increase in the number of surgical services in a highly demanded system), ERAS has boomed and, as the Canadian authors pointed out, its implementation should be considered a state policy.

In the current number, we present a review of the implementation of an enhanced recovery program (ERP) in liver surgery which we hope will be useful.