Development and implementation of a stratified enhanced recovery after surgery pathway for ventral hernia repair

Introduction: Enhanced recovery after surgery (ERAS) pathways are widely adopted in both major and minimally invasive surgeries. However, ERAS pathway implementation in ventral hernia repair (VHR) surgery remains an area of ongoing research given the variability in hernia complexity and surgical approach. To address this, our institution proposed and developed a stratified ERAS pathway to deliver effective, tailored perioperative care. Areas covered: This narrative describes the development of the ERAS pathway stratified to address the varied perioperative needs of VHR procedures, outline the evidence-based interventions comprising the bundle, describe the implementation process, and discuss the potential economic impact of implementing this pathway. We conducted a systematic literature search, last updated on 15 February 2024. Expert commentary: By leveraging the common elements of ventral hernia repair ERAS pathways, while addressing the perioperative needs of patients undergoing more complex procedures, a stratified pathway approach provides a practical and adaptable framework that balances intervention specificity with ease of implementation. While the introduction of conditional element modifications increases pathway complexity, it also facilitates patient-centered delivery of care. Operational expertise in organizing such pathways, as well as the implementation science behind it, is an opportunity to advance the frontiers of ERAS program developments.