Introduction. The Enhanced Recovery Program (ERP), Fast Track surgery (FTS), and ERAS (enhanced recovery after surgery/rapid recovery after surgery programs) is a multimodal and multidisciplinary treatment strategy designed to reduce the duration of disability and improve the quality of medical care. This program includes preparation at the preoperative stage, the use of minimally invasive techniques for performing surgical intervention and active management of the postoperative period to reduce the duration of inpatient treatment, rehabilitation time and the fastest possible return of patients to normal life. One of the key factors for the success of the ERP is the introduction of multidisciplinary interaction at all stages of examination and treatment. The history of the development of enhanced recovery programs is briefly described, the relevance of the development and application of an optimized treatment strategy, the problems of integration and multidisciplinary are described. The review of the features of the pathophysiology of perioperative stress and practical conclusions justifying the development and application of elements of the enhanced recovery program are presented.

Fast Track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery after surgery programs) or ERP (enhanced recovery program, in russian) is a multimodal and multidisciplinary treatment strategy designed to reduce the duration of disability and improve the quality of medical care. This program includes preparation at the preoperative stage, the use of minimally invasive techniques for performing surgical intervention and active management of the postoperative period to reduce the duration of inpatient treatment, rehabilitation time and the fastest possible return of patients to normal life. In the context of this review, the features of preparation and prehabilitation at the preoperative stage of the enhanced recovery program are considered. The main elements of the strategy are reviewed: correction of eating disorders, carbohydrate loading, preoperative education and problems of multidisciplinary interaction, sarcopenia, lifestyle changes, pharmacogenomics, correction of anemia and preoperative bowels preparation. Prehabilitation and preoperative preparation together help make the patient for surgery and subsequent recovery. The main elements of training are patient and staff training, multidisciplinary interaction, correction of concomitant somatic disorders and diseases, nutrition optimization and lifestyle changes.

A systematic review and meta-analysis of data on the problem of enhanced recovery in urology was performed. Inclusion criteria – clinical trials of the enhanced recovery program in urology.The aim of the study was to assess the significance of the enhanced recovery program (ERP) in the provision of surgical care in the “urology” profile.Materials and methods. The systematic review was performed according to the guidelines for the presentation of systematic reviews and meta-analyses by PRISMA. The registration number in the international system Prospero was received (CRD42022358982). The review included 364 studies. Studies in urologic oncology were excluded from the meta-analysis. The meta-analysis included 15 studies involving 2293 subjects. A comparison was made between the application of ERP and the standard treatment protocol.Results. The use of ERP leads to an expected two-fold reduction in the duration of postoperative length of hospitalization (OR = –1.96; 95% CI: –2.56÷–1.36; p < 0.00001). The reduction in the duration of hospitalization with the use of ERP in urology does not lead to the increased risk of readmission or re-operation (p = 0.35). The risks of developing postoperative complications ≥ Class 2 by Clavien – Dindo classification were comparable in both groups (p = 0.13). The use of ERP increases the expected success of the treatment by 1.74 times (OR = 1.74; 95% CI: 1.08–2.79; p = 0.02). With the use of ERP in reconstructive urology, a significantly lower risk of complications was established (p = 0.02).Conclusion. The ERP program allows you to reduce the time and cost of treatment, reduce the likelihood of re-hospitalization and achieve better treatment results. The use of ERP is not accompanied by increased risk of complications > Class 2.