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IMPORTANCE: Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement initiative now firmly entrenched within the field of perioperative care. Although ERAS is associated with significant clinical outcome improvements and cost savings in numerous surgical specialties, several opportunities and challenges deserve further discussion. OBSERVATIONS: Uptake and implementation of ERAS Society guidelines, together with ERAS-related research, have increased exponentially since the inception of the ERAS movement. Opportunities to further improve patient outcomes include addressing frailty, optimizing nutrition, prehabilitation, correcting preoperative anemia, and improving uptake of ERAS worldwide, including in low- and middle-income countries. Challenges facing enhanced recovery today include implementation, carbohydrate loading, reversal of neuromuscular blockade, and bowel preparation. The COVID-19 pandemic poses both a challenge and an opportunity for ERAS. CONCLUSIONS AND RELEVANCE: To date, ERAS has achieved significant benefit for patients and health systems; however, improvements are still needed, particularly in the areas of patient optimization and systematic implementation. During this time of global crisis, the ERAS method of delivering care is required to take surgery and anesthesia to the next level and bring improvements in outcomes to both patients and health systems.

Background:the enhanced recovery after surgery (ERAS) programme is an evidence-based pathway used to improve recovery after surgery. Despite consensus in the ERAS community that an ERAS nurse is necessary to the success of the programme, there is no definitive role profile.Objectives:this study aimed to define the role of the ERAS nurse and establish the main responsibilities.Methods:a literature review was undertaken, and a purpose-designed online survey was sent to all nurse members of ERAS UK.Data analysis:data are displayed as percentages with tables and charts.Results:33/89 ERAS nurses responded, describing their main roles as pathway development and implementation, data collection/audit, staff education and project management, as well as patient support and education throughout the pathway.Conclusions:roles vary considerably between ERAS nurses, their impact on the ERAS pathway is unclear, and more research is needed.