Advancing abdominal surgery recovery implementation: a unified framework for intensified recovery protocols by the EUropean PErioperative MEdical Networking collaborative

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Objective: To present the structure, implementation strategy, and early outcomes of the EUropean PErioperative MEdical Networking (EUPEMEN) project, a multinational initiative designed to reduce variability in Enhanced Recovery After Surgery (ERAS) implementation across European surgical centers through a structured educational and protocol-driven framework. Methods: EUPEMEN was conducted as a 26-month, prospective, multinational implementation initiative funded by the Erasmus + Programme and involving five academic institutions across Spain, Italy, Greece, and the Czech Republic. The project included protocol development, structured education, and dissemination strategies. Seven multidisciplinary procedure-specific Enhanced Recovery modules were developed using a modular design to allow adaptation across different healthcare systems. All materials were translated into five languages to enhance accessibility. A digital learning platform was created to host ten educational modules incorporating multimedia content and knowledge assessment tools. A train-the-trainer Learning Teaching Activity (LTA) was organized to prepare institutional representatives for local and national dissemination and multiplier events took place in participating countries to promote project dissemination. Process evaluation included participation metrics, structured governance monitoring, and documentation of implementation activities within participating hospitals. Results: Seven standardized Enhanced Recovery protocols covering major general surgical domains were successfully developed and disseminated. The online educational platform provided structured training and interactive assessment to registered users. Ten trainers participated in the LTA and subsequently supported national-level educational activities. Five multiplier events engaged 366 healthcare professionals from multidisciplinary backgrounds. Enhanced Recovery implementation was achieved in all partner institutions with incorporation of monitoring elements for future adherence evaluation. Additionally, the Via RICA pathway was translated into English and Greek, further supporting international dissemination. Conclusion: The EUPEMEN project represents a coordinated, multilingual, and education-centered multinational strategy for harmonizing Enhanced Recovery implementation across heterogeneous healthcare systems. By integrating structured protocol design, train-the-trainer methodology, and digital educational infrastructure, the project provides a scalable framework for bridging the Enhanced Recovery implementation gap in Europe. Long-term follow-up is required to assess protocol adherence and clinical impact.

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