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Enhanced recovery or ‘fast track surgery’was first described by Wilmore and Kehlet more than 10years ago. 1 Although initially associated with minimally-invasive laparoscopic surgery, other types of open surgery have been integrated into enhanced recovery pathways. Following its introduction in colorectal surgery, it is now advocated for many other specialities including urological, orthopaedic, gynaecological and breast surgery. 2–5 Enhanced recovery has transformed the delivery of perioperative practice and more recently it has been suggested that the key principles could be applied to acute medicine. 6 The core ethos of enhanced recovery is to speed up a patient’s recovery after surgery and improve patient outcomes, with associated benefits for staff and healthcare systems. Enhanced recovery pathways are underpinned by four principles: