Enhanced recovery after surgery (ERAS) programmes have transformed perioperative care across multiple surgical specialties. In cardiac surgery, ERAS Cardiac pathways integrate multimodal, evidence-based interventions to attenuate surgical stress, expedite recovery, and optimise resource use. This systematic review summarises contemporary evidence for ERAS protocols in adult cardiac surgery and evaluates their impact on clinical and health‑system outcomes. This review was conducted in line with PRISMA 2020 recommendations. Electronic databases (Medline, Embase, and the Cochrane Library) were searched for studies from 2010 to October 2025 evaluating ERAS or fast‑track pathways in adult cardiac surgery. Eligible studies compared a multicomponent ERAS/fast‑track protocol with usual care and reported at least one of the following: length of stay (LOS), complications, mortality, costs, or patient‑reported outcomes. Narrative synthesis was undertaken due to heterogeneity in interventions and outcome reporting. A PRISMA 2020 flow diagram is shown in Figure 1. Recent systematic reviews and meta‑analyses, together with large observational cohorts, demonstrate that ERAS Cardiac programmes are generally safe and are associated with reduced ICU and hospital LOS, lower rates of selected complications (especially pulmonary complications and delirium), decreased opioid exposure, and improved mobilisation without evidence of an increase in reintubation, readmission, or mortality. Key protocol elements include preoperative optimisation (education, prehabilitation, and anaemia management), minimally invasive surgical approaches when appropriate, goal‑directed anaesthesia with structured early extubation pathways, multimodal opioid‑sparing analgesia, and standardised early mobilisation and nutrition. Emerging economic evaluations suggest that ERAS Cardiac is cost‑saving or at least cost‑neutral despite upfront implementation costs, while limited data on patient‑reported outcomes indicate high satisfaction and perceived control over recovery. The available evidence supports ERAS Cardiac as a comprehensive framework that may improve recovery after cardiac surgery, primarily by shortening LOS and reducing complications and opioid use, without clear evidence of compromised safety. Wider implementation requires multidisciplinary engagement, local adaptation of turnkey order sets, robust audit, and inclusion of patient‑centred outcomes in future trials. High‑quality randomised and pragmatic studies focusing on long‑term functional recovery, health‑related quality of life, and cost‑effectiveness remain priorities.