In Reply We have carefully read the comments of Rozental et al regarding our published article.1 The authors suggest that the implementation of Enhanced Recovery After Surgery (ERAS) protocols not only decreases morbidity rate and hospital stay2 but, when used worldwide, it should reduce disparities in health care. We could not agree more. In this context, the relevant question has moved from documenting the effectiveness of the Enhanced Recovery Pathways (ERP) to detect which items are significantly associated with both better outcomes and adherence to the protocol. Our study showed that the adherence to ERAS protocols in colorectal surgery is low, and there are many centers that wrongly believe they are doing well with the compliance.1 Regarding disparities in health care, Europe could be in some way different to the United States, but a study conducted in Scandinavia3 has found that although their centers have a greater adherence to the protocol than the Spanish ones, there is a great disparity within compliance between hospitals.3
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Ripollés-Melchor J, Ramírez-Rodríguez JM, Aldecoa C. Role of Adherence to Enhanced Recovery After Surgery Programs in Mitigating Healthcare Disparities—Reply. JAMA Surg. 2020;155(1):92. doi:10.1001/jamasurg.2019.3498
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