What is ERAS?

ERAS (Enhanced Recovery After Surgery) is the term used to describe the concept of multimodal, perioperative interventions to improve postoperative outcomes. The program was introduced more than 10 years ago and today there is ample evidence that it accelerates postoperative recovery, shortens hospital stay, morbidity and recovery time. Although different terminologies are used, it is generally called ERAS in Europe and fast track in the United States. The studies conducted by Prof. Henrik Kehlet from Denmark in the late 1990s laid the foundations for the formation of this protocol, which is why he is known as the creator of ERAS. ERAS recommends changes to the entire journey of a patient, starting before surgery and ending at home. The protocol includes more than 20 evidence-based elements to be implemented in the perioperative period. In meta-analyses published in recent years, it was emphasized that by applying ERAS protocols in major surgeries, the length of hospital stay was shortened by 2-3 days and complications were reduced by 30-50%.

Philosophy of ERAS

ERAS proposes changes to the entire journey of a patient, starting in the outpatient clinic before surgery and ending at home upon discharge (Figure 1).

Figure 1: Patient’s Surgical Journey

The basic philosophy of the protocol is to reduce metabolic stress due to surgical trauma, support the normalization of functions in a short time, and ensure that normal activity is returned as soon as possible.

One of the most important factors in the recovery after conventional surgery is to combat the metabolic trauma caused by surgery. The aim is to reduce the metabolic response to trauma through modern anesthesia, analgesia and some support applications defined by ERAS. Thus, less damage will result in a quick recovery. The important point to remember is that ERAS is not the unconventional applications of a surgeon but the performance of a team. Although different members of a team contribute to the process from hospital admission to complete recovery at home, the surgeon, anesthesiologist and nurse stand out as the leading actors. Under the leadership of these basic members of the team, all members should meet once every 15 days at most, evaluate the results and conduct training activities.

ERAS protocols go beyond traditional, even dogmatic, surgical and anesthesia practices and bring innovations that can be described as radical.