Understanding Perceptions, Knowledge and Implementation Barriers of Enhanced Recovery After Surgery Among Surgeons and Anesthesiologists.

Objective The present study aimed to evaluate the knowledge, perceptions, and barriers associated with Enhanced Recovery After Surgery (ERAS) implementation among perioperative clinicians. Methods This cross-sectional study included responses from 214 perioperative clinicians, comprising surgeons and anesthesiologists involved in abdominal surgeries, from tertiary care hospitals in Khyber-Pakhtunkhwa, Pakistan. A structured questionnaire collected data on participants' knowledge of ERAS protocols, perceived barriers to implementation, and learning preferences. Responses were analyzed using descriptive and inferential statistics, with significance set at p<0.05. Results This study included 214 perioperative clinicians, predominantly residents (91.6%, n=196), from surgery (90.2%, n=193) and anesthesiology (9.8%, n=21) departments. Knowledge about ERAS protocols was limited, with 89 (41.6%) of respondents stating they knew nothing and 97 (45.3%) reporting very little or some familiarity. Perceived barriers included lack of institutional support, time constraints, and insufficient research. Most participants, 145 (67.8%), supported integrating ERAS education into formal training, with 92 (42.9%) favoring seminars or lectures and 79 (36.9%) preferring journal articles for learning. Perceptions of ERAS importance were generally positive, but significant differences were noted regarding hospital administration support (p=0.013). Conclusion This study identifies significant gaps in ERAS knowledge among perioperative clinicians, particularly among residents, and highlights perceived logistical barriers to its implementation. However, the findings are limited by the underrepresentation of consultants and anesthesiologists, who are key drivers of ERAS programs. The findings highlight the need for targeted educational interventions, stronger institutional support, and multidisciplinary collaboration to improve ERAS adoption.