ERAS—Enhanced Recovery After Surgery

Abstract

ERAS is the acronym for enhanced recovery after surgery, a term often used to describe perioperative care programs that have been shown to improve outcomes after major surgery. This article gives a brief history of the development from fast-track surgery to ERAS. Today, the full meaning of ERAS goes beyond just a protocol for perioperative care with the initiation of a novel multiprofessional, multidisciplinary medical society: the Enhanced Recovery After Surgery Society for Perioperative Care (www.erassociety.org). The ERAS Society is involved in the development of evidence-based guidelines. These guidelines form the basis for an implementation program of the ERAS principles to practice. While ERAS was initially developed for colonic resections, these principles are being used in a range of operations, and there is also a continuous update of care protocols as the fields develop. A key mechanism behind the effectiveness of ERAS is the dampening of the stress responses to the surgical insult combined with the use of treatments that support return of functions that delay recovery in traditional care. The article also gives some insights to why the protocols work and reports the effects of ERAS protocols.

Prophylactic air‐extraction strategy after thoracoscopic wedge resection

“…Enhanced recovery after surgery describes a multimodal perioperative care program 1, 22. Tubeless strategies are a major area of interest within the field of ERAS for thoracic surgery 23.…”

“…The enhanced recovery after surgery (ERAS) protocol was first introduced in 2001, and focuses on patient recovery rather than fast discharge 1. ERAS has increased in popularity in recent years and has become the central theme of perioperative protocol in multidisciplinary works.…”

The Perioperative Surgical Home and Enhanced Recovery After Surgery: Perspectives from Two Continents

“…A large cohort study of 6000 patients, comparing an ER arthroplasty cohort to a traditional control found that ER patients can reduce length of stay (LOS) and need for blood transfusion [15] . Others have corroborated these findings [12][13][14][15][16][17][18][19][20] . Other advantages include reduction of both 30-day incidence of myocardial ischaemic events (p = 0.03) and 30-day mortality (p = 0.03) [15] .…”

“…A piecemeal adaptation of ER took place throughout the UK NHS in the early 2000s [14] . Economic austerity and rationalisation of healthcare spending has led to the Department of Health championing ER.…”

“…Both Involvement and support of senior executive management and primary care from the very outset of the project, in addition to the surgeon, anaesthetist, and nursing staff, is essential [17,49,61] . Secondly, the logistical difficulty of changing ward protocols, and reorganisation of services for implementation of such a model, may impede its delivery [14,61] . Compliance to protocols and completing required documentation may be taxing.…”