Enhanced Recovery after Surgery: Adopting a New Standard of Success
Enhanced Recovery after Surgery (ERAS) programs represent a paradigm shift in the delivery of care to surgical patients. Multiple large studies have demonstrated 50% reduction in complications, 30-50% reduction in length of hospital stay, improved patient satisfaction and savings of $5000 - $10,000 per patient following the implementation of ERAS programs.
First proposed and implemented in Denmark in 1994, ERAS has proven to be wildly successful. Enhanced recovery is now promoted in over 20 countries and guidelines for ERAS are published by 12 major surgical societies. Increasingly, ERAS programs are promoted directly to patients by large health care organizations such as the Mayo Clinic, Cleveland Clinic, Duke, and USCF as part of their marketing strategy.
By definition, ERAS pathways involve many different medical and surgical disciplines; are multimodal in nature; apply evidence based, best care practices; and follow patients through the entire surgical journey. The implicit goal of each ERAS program is to attenuate iatrogenic stress, maintain perioperative physiologic function, reduce complications and accelerate the return of each patient to normal health. Quite simply, an ERAS program systematically provides the best scientifically proven care to every patient having surgery from contemplation of surgery to return to health.
Designing, implementing and maintaining a successful ERAS program is challenging in spite of its conceptual simplicity. Many different stakeholders must come together to build each program. It is common for a program to have well over 25 individual elements that all need to be coordinated at different times. Order sets and care pathways must be created and published. Champions must be recruited to support all involved disciplines – physicians, nurses, therapists, nutritionists. Multiple education forums are essential to create provider engagement and minimize opportunities for miscommunication. Data acquisition and ongoing data analysis are critical. (Experience has shown that a 70% adherence to an ERAS program is necessary for success and ongoing monitoring is required to prevent gradual loss of early success.)
The members of the Preoperative Assessment Center (PAC) have developed the expertise to assist individual surgical departments design, implement, and maintain a robust ERAS program. The PAC is also involved in continual refinement and expansion of the data analytics needed to support ERAS programs and associated research. The members of the PAC and Department of Anesthesiology look forward to continued expansion and success in the field of Enhanced Recovery after Surgery at the University of Minnesota.