An umbrella review examined 24 ERAS Society guidelines published between 2013 and 2025, looking for what is common across procedures rather than what is specific to each. Anaesthesiological involvement was identifiable in 23 of the 24.
Of 45 umbrella terms assessed, eight were consistent across all guidelines: multimodal analgesia, fasting, thromboprophylaxis, antimicrobial prophylaxis, nutrition, temperature management, fluid management and surgery-specific recommendations. Ten more were mostly consistent, and 27 were mixed or sparse.
That split is the useful part. A unit trying to implement ERAS across several specialities does not need a separate protocol per operation for most of what matters — eight domains carry across all of them, and building those once is more achievable than maintaining twenty procedure-specific documents.
The authors also flag the domains where guidelines agree that something matters but disagree on the strength of the recommendation: fluid management, preoperative carbohydrate loading and pre-anaesthetic medication. Those are the ones that need local appraisal rather than adoption, because the guidance itself is not settled. Mean AGREE II score was 76%, lowest for stakeholder involvement — which is worth knowing before quoting a guideline at a surgical colleague who was not consulted in writing it.
- Build the eight consistent domains as one cross-speciality protocol rather than per procedure.
- Treat fluid management, carbohydrate loading and pre-anaesthetic medication as local decisions — the guidelines disagree.
- Recommendation strength and cross-guideline frequency are different things; check both.
- Stakeholder involvement was the weakest AGREE II domain across these guidelines.
The statistics, in plain English
AGREE II scores how well a guideline was developed and reported — its scope, rigour, clarity and independence — not whether its advice is correct. A mean of 76% is respectable; the low score for stakeholder involvement means the people affected were not well represented in developing them, which is a fair criticism to raise and not a reason to discard the content. The consistency counts here are descriptive: eight of 45 terms appearing across all 24 guidelines tells you what the field agrees matters, not how large any effect is. Nothing in this paper measures an outcome in a patient.
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