Implications of Practice Variability: Comment

We applaud Sessler and Memtsoudis for sounding the alarm about the unbridled enthusiasm for ERAS protocols.^1,3,4 As Sessler opined:“There is no basis for giving clinical pathways a ‘free pass’ on evidence.”¹ Indeed, we applaud Anesthesiology for increasing the volume of the alarm bell with publications like the randomized, controlled trial by Maheshwari et al.² Publication of such “negative” trials⁴ is vital to separating valid ERAS elements from unnecessary or perhaps even detrimental components of proposed pathways. “Great expectations” for ERAS may indeed prove to be true, but in 2020 we still don’t know whether the reality equates to the hype. Regardless, it is time to put the evidence in ERAS.^1,5