ERAS: Enhanced Recovery After Surgery

Enhanced Recovery After Surgery (ERAS) Programme

There is a significant volume of published data showing improved recovery after elective surgery when a structured care pathway involving a collection of strategies is applied. This approach modifies surgical pathophysiology, and addresses psychosocial and environmental factors that may contribute to post-operative morbidity.

Pre-operative strategies:

1. Pre-op information

- verbal (in rooms)

- written

- discharge planning

- ward visit

2. “Prehabilitation”

- stop smoking

- alcohol abstinence

- assessment of social circumstances

- consider pre-op exercise programme

3. Consider pre-op IMPACT, if:

- weight loss >10% in 6 months

- BMI <18.5

- Albumin <30

- Subjective Global Assessment grade C

4. For morning operation: 300ml carbohydrate drink on going to bed night before operation + 300ml on waking the morning of the surgery (no later than 6 am).

For afternoon operation: 300ml carbohydrate drink at 7.30 am on the morning of surgery + 300ml at 11.30 am on the morning of the surgery.

Powerade Recovery or Isotonic; Gatorade

5. Minimise the use of mechanical bowel preparation

Intra-operative strategies:

1. Routine use of peri-operative prophylactic antibiotics

2. Peri-operative hyper-oxygenation (80% FIO2)

3. Routine use of DVT prophylaxis (Clexane/TEDS/pneumatic calf compression)

4. Minimise intra-operative IV fluids

5. Maintenance of normal core body temperature

6. (Avoidance of drain tubes when safe)

7. (Avoidance of nasogastric tube when safe)

Post-operative strategies:

1. Multimodality analgesia to minimise use of narcotic analgesia

2. Routine early oral feeding and dietary supplementation

a. encourage Sustagen, Resource, IMPACT, “sports drinks”

b. discourage water

c. solids foods as tolerated from first post-op day

3. Early removal of urinary catheter

4. Early mobilisation