Newly Published
Correspondence  |   July 2020
Implications of Practice Variability: Comment
Author Notes
  • University of Minnesota Medical School, Minneapolis, Minnesota (R.C.P.). prielipp@umn.edu
  • This letter was sent to the author of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.
    This letter was sent to the author of the original article referenced above, who declined to respond.—Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.×
  • Accepted for publication June 19, 2020.
    Accepted for publication June 19, 2020.×
Article Information
Correspondence
Correspondence   |   July 2020
Implications of Practice Variability: Comment
Anesthesiology Newly Published on July 14, 2020. doi:https://doi.org/10.1097/ALN.0000000000003466
Anesthesiology Newly Published on July 14, 2020. doi:https://doi.org/10.1097/ALN.0000000000003466
If Charles Dickens were alive today, he might be convinced to pen an epic about the current state of perioperative medicine instead of a nineteenth-century 7-yr-old orphan. But just as Pip painfully learned how readily Great Expectations can evaporate, we believe anesthesiology must avoid a similarly painful downfall by immediately adopting vigorous testing procedures to the great expectations of enhanced recovery after surgery (ERAS) programs. ERAS requires the same scientific inquiry, systematic collection and analysis of quality outcome data, and statistical validation—quite simply EVIDENCE—that are required of pharmaceutical medications and medical devices.
Thus, we applaud Dr. Sessler’s editorial “Implications of Practice Variability” in the February issue of Anesthesiology,1  in which he opines that the rampant proliferation of perioperative protocols, pathways, and ERAS guidelines vastly exceeds the sustaining scientific evidence. But we humbly suggest that Dr. Sessler’s editorial may not have gone far enough in raising the alarm about instituting new, obligatory clinical pathways as “best practices” when the published evidence for such interventions is either absent, contradictory, or statistically inadequate. Moreover, of greatest concern is the common practice whereby medical centers and ERAS committees invoke new clinical pathways, but omit the commensurate requirement for concurrent, parallel, and meaningful (i.e., more than just hospital discharge) patient data to provide definitive answers to whether these protocols indeed improve patient value as well as hospital efficiency. We posit that the future of ERAS must embrace three key concepts.