Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed for the early recovery of patients undergoing surgery. (To watch a video about ERAS at Duke, visit https://www.youtube.com/watch?v=iUQe1QOgyRs.) Despite adoption in Europe and a 2014 Duke-led study demonstrating that enhanced recovery worked well for colorectal cancer patients, it can be challenging for institutions to change from traditional approaches in perioperative care.
A national effort is now underway to spread the evidence-based findings on earlier recovery. Spearheaded by co-author of the 2014 study, Julie K. Marosky Thacker, MD, the American College of Surgeons is sponsoring the national initiative to reduce hospital stays and readmissions with this approach. She is co-founder of the nonprofit American Society for Enhanced Recovery to educate operating-room teams and says that many traditional practices have been disproved.
Examples of the new recommended practices that were tested and became formal Enhanced Recovery Focus Elements at Duke include:
- Asking patients to not ingest food for a period of only 6 hours before colorectal surgery
- Ensuring that a patient is strong or participates in a strengthening program before surgery
- Emphasizing an early diet and early mobility as soon as possible after surgery to strengthen a patient.
Although surgeons generally infuse fluid during surgery (wartime studies had showed the practice to be beneficial and to confer extended survival in trauma patients), this practice isn’t necessary for the average patient, Thacker says. “Giving extra IV fluids to overcome the starvation we’ve imposed on patients leads to worse outcomes,” such as preventing bowel function from returning to normal, she said in a March 31, 2015, Wall Street Journal article.
In addition to colorectal surgery, the ERAS approach has been expanded at Duke University Hospital to include bladder, pancreas, gynecologic, and liver surgeries. ERAS is particularly beneficial in patients who have a risk of complication, such as those with cancer.
In a May 2014 article published in the journal Anesthesia & Analgesia, Duke researchers reported that the enhanced recovery approach used for colorectal surgery cut hospital admissions from an average 7 days to 5 and reduced the rate of readmissions by one-half.
The Duke team collected data from 241 consecutive patients at Duke University Hospital undergoing open or laparoscopic colorectal surgery during two time periods: before the enhanced recovery approach was implemented and after. Ninety-nine patients were cared for in the traditional approach, and 142 received enhanced recovery. Cost savings were seen in about 85% of the ERAS patients, estimated at about $2,000 per patient.