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ERAS Pathway Evidence — FRCA Final MCQ

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EasyPerioperative MedicineERAS Pathway EvidenceFRCA Final

A 25-year-old man (ASA I, 80 kg) is scheduled for arthroscopic ACL reconstruction. He is healthy with no comorbidities. Regarding enhanced recovery after surgery (ERAS), which single intervention has the greatest evidence for reducing length of hospital stay after major surgery?

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Correct answer: B — Multimodal ERAS pathway implementation (combining all elements)

ERAS protocols combine multiple evidence-based perioperative interventions including: preoperative counselling and carbohydrate loading, avoidance of prolonged fasting, multimodal analgesia (regional blocks, paracetamol, NSAIDs, minimising opioids), PONV prophylaxis, goal-directed fluid therapy, early enteral nutrition, early mobilisation, and early catheter/drain removal. The synergistic effect of implementing the full pathway provides greater benefit than any single intervention. Meta-analyses consistently show that ERAS pathways reduce length of stay by 30-50% and complications by 30-40% compared to traditional care.

Reference: ERAS Society – 2019 – Enhanced Recovery guidelines; RCOA – 2023 – Perioperative medicine