Understanding the Enhanced Recovery After Surgery (ERAS) Protocol
Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based approach designed to standardize and optimize surgical care. It aims to reduce the body's stress response to surgery, minimizing complications and accelerating recovery through interventions before, during, and after the procedure. This pathway relies on collaboration between a multidisciplinary team and the patient.
The Critical Role of the Preoperative Phase
The preoperative phase is essential in getting the patient into optimal condition before surgery. This contrasts with traditional care that often involved prolonged fasting. ERAS emphasizes the patient's active participation and addresses modifiable risk factors.
Key Components of Preoperative ERAS
Implementing evidence-based strategies during this phase improves patient outcomes.
Patient Education and Counseling
Education begins early, informing patients and families about ERAS, setting recovery expectations, and discussing goals like pain management and early mobility. Providing educational materials reinforces this information.
Nutritional Optimization
ERAS reduces fasting times, allowing clear liquids up to two hours before elective surgery. Carbohydrate-rich drinks before surgery help maintain energy and reduce postoperative insulin resistance.
Medical and Risk Factor Assessment
A thorough health assessment identifies and manages pre-existing conditions. Patients receive counseling on lifestyle changes like smoking cessation, and some may benefit from prehabilitation programs.
Prophylactic Interventions
Standard prophylaxis includes antibiotics before incision to prevent infection and measures to prevent blood clots (VTE). Preemptive non-opioid pain medication is also given.
Preoperative vs. Traditional Care
| Feature | ERAS Preoperative Phase | Traditional Preoperative Care |
|---|---|---|
| Patient Involvement | Patient and family are actively involved and educated on their role in recovery. | Patient is passive; recovery expectations may be less clear. |
| Fasting | Minimal fasting, with clear liquids permitted up to two hours before surgery. | Standard fasting from midnight, leading to dehydration and stress. |
| Nutrition | Carbohydrate loading drink given 2–3 hours before surgery to maintain energy levels. | No nutritional optimization; risk of insulin resistance is higher. |
| Bowel Prep | Selective or no mechanical bowel preparation, reducing dehydration and electrolyte imbalance. | Routine mechanical bowel preparation, which can cause significant fluid and electrolyte shifts. |
| Analgesia | Preemptive, multimodal non-opioid medication strategy. | Pain management relies more heavily on postoperative opioid administration. |
The Multidisciplinary Team in the Preoperative Phase
Effective ERAS requires a coordinated team. The surgeon identifies patients and coordinates care. The anesthesiologist assesses risks and plans anesthesia. Nurses and coordinators educate patients and ensure protocol adherence.
Conclusion: The Impact of Optimizing the Preoperative Phase
Optimizing the preoperative phase significantly influences surgical outcomes. A focus on education, nutrition, assessment, and prevention supports faster, safer recovery for patients.
To learn more about the scientific basis for ERAS, consider reviewing {Link: guidelines from the ERAS® Society https://erassociety.org/guidelines/}.
