Part 1: What is ERAS? | Enhanced Recovery After Surgery series

In recent years, more facilities are adopting the principles of the Enhanced Recovery After Surgery (ERAS) protocol, which aims to reduce the physiological stress of surgery in an effort to promote faster and easier recovery. Nutrition is a central component in both the pre- and post-op treatment of ERAS patients.

Surgical patients often find themselves on a dietitian’s radar. Either they have been NPO for a lengthy time, they are receiving some sort of nutrition support, or they require pre- or post-op diet counseling. Dietitians are tasked with optimizing these patients’ nutrition status both before and after surgery.

In this three-part series, we will introduce the concept of ERAS, discuss in detail the role of nutrition, and reveal the surprising effects ERAS has on patient outcomes.

A review of traditional surgical concepts

For decades, surgical patients have been treated with extreme care and caution. It was long believed (and still practiced) that patients should fast after midnight before an operation to ensure an empty stomach and reduce the chance of aspiration, if regurgitation should occur on the operating table.

During the operation, general anesthesia, liberal IV hydration, and nasogastric tubes, drains, and catheters are routinely used. Post-operatively, any oral or enteral nutrition is withheld — often for several days — until a subjective measure of bowel function returns. Patients are not routinely mobilized, but rather remain on bed rest.

Narcotics are commonly used for pain management. And nausea and vomiting rear their ugly heads as gut motility grinds to a halt. Sound familiar? These outdated practices often extend lengths of stay, thereby making any hospital stay less than 5 to 7 days a pleasant (albeit, suspicious) surprise.

ERAS: A better way

ERAS has its roots in Europe in the early 2000s, with the first protocol being published in 2005. The protocol challenges many of traditional beliefs and surgical practices and addresses the entire perioperative period.

Some of the key components of ERAS are to optimize the patient’s nutrition status both pre- and post-op, provide adequate pain control without the use of narcotics, mobilize the patient early in the post-op period, and avoid the unnecessary use of tubes, drains, and catheters. See below for an overview of all the ERAS components.

Image: Fearon, et al. Clin. Nutr. 2005;24(3):466-477.

This change in surgical care effectively reduces the physiological stress of surgery, reduces complications, and promotes an earlier discharge and faster recovery.

What’s next?

In the next installation of the ERAS Series, we will delve deeper into the pre- and post-op nutrition recommendations for surgical patients. You don’t want to miss it!

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References:

Fearon KCH, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin. Nutr. 2005;24(3):466-477.

History. ERAS Society website http://erassociety.org/about/history/. Updated 2016. Accessed July 11, 2018.

Nanavati AJ, Prabhakar S. Enhanced recovery after surgery: if you are not implementing it, why not? Practical Gastroenterology. 2016;Apr:46-56.