Enhanced Recovery Program: ERAS

What is ERAS? ERAS is an acronym for enhanced recovery after surgery. The acronym is commonly used to describe a multimodal perioperative care program. The term enhanced recover after surgery can be and often is substituted for terms like enhanced recovery programs (ERP) or fast-track surgery, but ultimately the meaning is the same. Every program of ERAS is composed of several evidence-based perioperative care aspects that have been proven to be effective; however, when each aspect is put together into a protocol, they have been shown to result in substantially improved surgical outcome. The number of aspects in each ERAS protocol is different, but a common number is approximately twenty. Enhanced recovery after surgery protocols in major
Dr. Kehlet and colleagues at the University of Copenhagen had the highest compliance than everyone else due to their familiarity with such protocol. When all parties realized their lack of compliance, they decided to aim for adoption of the ERAS best practice protocol while studying the change of practice. When the group monitored their change of practice it became clear that just having a uniform protocol was not enough so the decision to create and use a common database was made. Every consecutive patient from that point forward was inputted into the database for monitoring which led to an unintended revelation. The treatment at each organization that belonged to the study group was different from what the group thought. When each partner in the study group reviewed their individual best practices, they learned that everyone had problems with compliance to protocols with aspects they thought were working well. The database audit helped the group to identify true best practice and helped them make the correct changes so they could focus on areas where problems actually existed. The fact that some organizations were employing treatments that were opposed by other clinicians in other units made it easier for detractors to accept the different philosophy of practice. The study group made it a focus to met regularly during the early years of ERAS so they could support each other and present their findings. The result was improvements in compliance and outcomes emerged. In addition to their regular meetings, the group distributed surveys that found their organizations were not alone in keeping with outdated traditions and care instead of adopting better more evidence-based