If Charles Dickens were alive today, he might be convinced to pen an epic about the current state of perioperative medicine instead of a nineteenth-century 7-yr-old orphan. But just as Pip painfully learned how readily Great Expectations can evaporate, we believe anesthesiology must avoid a similarly painful downfall by immediately adopting vigorous testing procedures to the great expectations of enhanced recovery after surgery (ERAS) programs. ERAS requires the same scientific inquiry, systematic collection and analysis of quality outcome data, and statistical validation—quite simply EVIDENCE—that are required of pharmaceutical medications and medical devices.

Thus, we applaud Dr. Sessler’s editorial “Implications of Practice Variability” in the February issue of Anesthesiology, in which he opines that the rampant proliferation of perioperative protocols, pathways, and ERAS guidelines vastly exceeds the sustaining scientific evidence. But we humbly suggest that Dr....

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