Surgery often has long-term benefits, but it also causes massive stress to the body. The more prepared your health care team is to help your body deal with surgery, the smoother the recovery process will be. Enhanced Recovery After Surgery (ERAS) is a unique process that a surgical team follows to ensure patients have the best possible outcomes from surgery. These guidelines cover the patient journey throughout the entire surgical process.
ERAS is a patient-tailored process that was first introduced in 1997 by a group of general surgeons. The main focus of this model of care is to improve patient outcomes from surgery, specifically by:
- Reducing the length of hospital stays
- Lowering complication rates
- Helping patients achieve early recovery
Since it was first introduced, ERAS has continued to gain recognition as an ideal approach to for all types of surgeries, including orthopaedic surgery. In 2010, the ERAS Society was officially established. It is an international non-profit organization made up of members from a variety of medical professions. Dr. Romeo’s patients follow ERAS protocols before, during, and after their surgical procedures to minimize the effects of anesthesia, reduce post-op pain, and speed up recovery.
“Enhanced Recovery After Surgery protocols largely improve patient outcomes and satisfaction while also reducing the overall cost of care.”
Benefits
ERAS improves patient outcomes and satisfaction. It also reduces the overall cost of care by helping patients recover faster and spend less time in hospital. ERAS programs are safer and more effective than traditional care, as patients have a reduced chance of developing complications.
When ERAS protocols are followed, patients can regain strength and improve their quality of life not only immediately following surgery but also in the long term.
Elements of ERAS
The elements of ERAS can be broken down into four stages:
Before admission. The first step of ERAS involves patient evaluation and education, often weeks before surgery. The health care team assesses the patient and offers customized guidance on nutrition, hydration, fitness, and overall health to help them reach their best medical condition before surgery. The care team will also try to improve any health conditions, such as high blood pressure or high blood sugar, that may impact surgery.
This stage also largely focuses on optimizing nutrition. Poor nutrition can mean worse surgical outcomes with more complications, longer hospital stays, and higher medical costs. To minimize these risks, patients receive counselling from a dietitian or nurse to ensure that their nutritional status is optimal. For example, patients with inadequate protein intake may be offered a standard liquid protein supplement to help prevent weight and muscle loss during and after surgery.
Before surgery. A traditional approach to surgery require patients to fast (or refrain from eating) for many hours beforehand. ERAS protocols, however, require less fasting, allowing some patients to consume solids up to six hours before surgery and clear fluids up to two hours before surgery. (Of note, the newer weight loss drugs using semaglutatide may impair gastric digestion and therefore require a much longer period of fasting prior to surgery.)
A less restricted approach to pre-op food intake may benefits some patients in a number of ways, including:
- Reduced insulin resistance and better blood sugar levels
- Reduced nitrogen and protein loss after surgery
- Preserved skeletal muscle mass
- Less thirst, hunger, and anxiety before surgery
During surgery. The ERAS approach minimizes stress to the body during surgery. Under ERAS, the health care team administers customized doses of anesthesia, fluids, and medications to the patient. Patients may be given spinal, regional, and local anesthetics, which are less stressful to the body compared to a general anesthetic. The amount of fluid in patients’ bodies is also carefully controlled.
After surgery. Following surgery, the health care team focuses on helping the patient get back to walking, eating, and decreasing their pain medication as early as possible. Early physical therapy is another common feature of ERAS. Pain is controlled by a multimodal analgesia approach, which uses different types of pain medication to help reduce opioid use. Helping patients get back to their normal activities and return home as soon as possible ensures that they reach optimal recovery.
The goal of ERAS is to get patients better, faster. Surgeons and facilities that use ERAS aim to provide a modern approach to minimally stressful surgeries that allow patients to get home and healing as soon as possible.
