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

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. 

ERAS Flow Chart

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.

Implementation

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.

ERAS_Challenges

Disclaimer

​​​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 material at those sites, or any associated organization.

ERAS Protocols

Webinars

Articles and White Papers

Other Resources

ERAS_Book

Members: Download ​a complimentary copy of "Enhanced Recovery for Major Abdominopelvic Surgery", an eBook published for the American Society for Enhanced Recovery (ASER)