Enhanced Recovery after Surgery
Enhanced Recovery after Surgery (ERAS) refers to patient-centered, evidence-based, multidisciplinary team developed pathways for a surgical specialty and facility culture to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery. These care pathways form an integrated continuum, as the patient moves from home through the pre-hospital / preadmission, preoperative, intraoperative, and postoperative phases of surgery and home again.
AANA Practice Considerations
- Enhanced Recovery After Surgery - How CRNAs are reducing opioid use, improving outcomes, and lowering costs
Elements of an ERAS program
Though individual elements of an ERAS pathway are beneficial, implementation and compliance with patient appropriate elements of a comprehensive pathway across the entire perioperative continuum have been shown to improve outcomes. The key elements of ERAS include patient/family education, patient optimization prior to admission, minimal fasting that includes a carbohydrate beverage two hours before anesthesia, multimodal analgesia with appropriate use of opioids when indicated, return to normal diet and activities the day of surgery, and return home. Anesthesia professionals deliver many of the enhanced recovery elements that are summarized in the figure below.
Advantages of Implementation
Research has consistently shown that adoption of enhanced recovery leads to significant improvements in patient satisfaction, outcomes and reduction in cost of care. Specifically, patients experience faster recovery, shortened hospital stay and significantly fewer complications. To successfully integrate ER into practice, a structured, collaborative, multidisciplinary approach accompanied by education and awareness campaign may be valuable.
Successful change management and ERAS implementation occurs as a process that evolves from leadership, creation of the climate for change, and engagement and empowerment of those involved, through the development of a change initiative, implementation or trial of the pathway, and sustained change with continued improvement. Specific areas where ERAS programs have faced implementation challenges may be attributed to the following: patient-related, staff-related and practice-related factors. Recognition of these challenges in the development and improvement of your program may be helpful for the long-term success of an ERAS program.
The resources on this page may incorporate or summarize views, guidelines, or recommendations of third parties. Such material is assembled and presented in good faith, but does not necessarily reflect the views of the AANA. Links to third-party websites are inserted for informational purposes and do not constitute endorsement of the material on those sites, or of any associated organization.
- ERAS Protocol Can Cut Opioid Use After Spine Surgery
- American Society for Enhanced Recovery (ASER) Protocols
- ERAS Society Guidelines
- Peri-Operative Patient Simulation (POPS) - Intraoperative Goal Directed Fluid Therapy Protocols
- Perioperative Goal-Directed Therapy Protocol Summary
- Enhanced Recovery for Abdominal Surgery Clinical Pathway
- University of California, Irvine - Goal-Directed Therapy
- National Implementation of an Enhanced Surgical Recovery Program
- Hemodynamic Management of Patients: Taking the Guess Work out of the Equation
- Intraoperative Goal Directed Therapy: An Update on the Evidence for Improving Patient Outcomes
- Perioperative Goal Directed Therapy with Non-Invasive and Minimally Invasive Monitoring
- The Clinical and Economic Impact of Perioperative Goal-Directed Hemodynamic Therapy
- Hemodynamic Monitoring: Wet, Dry or Even?
- Fluid Responsiveness in the Critically Ill Patient
- Introduction to Enhanced Recovery After Surgery
- TriHealth Surgical Institute - Enhanced Recovery Program
Articles and White Papers
- Awake Lumbar Interbody Fusion
- ACCRaC Episode 88: ERAS For Cardiac Surgery, Anesthesiology News, July 2018
- American Society for Enhanced Recovery: Advancing Enhanced Recovery and Perioperative Medicine, Anesthesia & Analgesia, June 2018
- American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway, Anesthesia & Analgesia, June 2018
- American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery, Anesthesia & Analgesia, June 2018
- American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway, Anesthesia & Analgesia, June 2018
- Enhanced Recovery after Surgery: Implementation Strategies, AANA NewsBulletin, November 2017
- Development and Implementation of a Colorectal ERAS Pathway, Anesthesiology News, October 2017
- Perioperative Medicine - An open access journal that publishes highly topical clinical research relating to the perioperative care of surgical patients.
- Article Resource List
- Why Cardiac Output?
- Stroke Volume Variation
- Theory and Clinical Application of Continuous Fiberoptic Central Venous Oximetry (ScvO2) Monitoring
- Enhanced Recovery Programs: Perioperative Care Pathways To Improve Outcomes and Value, Anesthesiology News, September 2016
- Enhanced Recovery: Perioperative Pathways Leading to Better Outcomes, Anesthesiology News, January 2016
- New Care Approach to Liver Operations Speeds Patient Recovery, Journal of the American College of Surgeons, October 21, 2015
- Perioperative Care Pathways for Enhanced Recovery and Anesthesia, AANA NewsBulletin, May 2015
- Enhanced Recovery Pathways for Major Abdominal Surgery, Anesthesiology News, December 2014
Members: Download a complimentary copy of "Enhanced Recovery for Major Abdominopelvic Surgery", an eBook published for the American Society for Enhanced Recovery (ASER)