Enhanced Recovery After Surgery (ERAS) Protocols in Sarcoma and Metastatic Bone Disease: A Scoping Review

Literature evaluating the effectiveness of Enhanced Recovery After Surgery (ERAS) pathways in orthopaedic oncology, particularly in bone and soft tissue sarcomas, is varied and has not been synthesized to understand the current state of evidence. However, substantial efforts have been made to evaluate ERAS in other orthopaedics procedures, particularly in hip and knee arthroplasty. This study aims to summarize the breadth and depth of literature on ERAS pathways in orthopaedic oncology to identify critical gaps and guide future research directions given the potential benefits in this complex population. The Arksey and O’Malley framework in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used to generate a search strategy, define eligibility, and select studies from a comprehensive literature search. Of the nine included studies, data were extracted and analyzed using descriptive analytics. The available literature was heterogeneous; it predominantly comprised retrospective studies, concentrated on spine and spinopelvic oncology, ERAS components included, and reported outcomes (although length of stay was assessed in all included studies). Comparatively little evidence was identified in non-spine sarcoma, and no included study specifically evaluated appendicular metastatic bone disease. These findings highlight the need for prospective disease- and surgery-specific ERAS implementation studies using standardized pathway definitions, adherence measures, and perioperative outcomes.