Enhanced Recovery After Surgery (ERAS) Program to Improve Surgical Outcomes

There is growing evidence that patient recovery from surgery can be enhanced through pre and perioperative interventions. However, one of the challenges in translating knowledge into practice is turning paper-based recommendations into actions. Even when practitioners are aware of evidence, there is a lag of 11-17 years to translate research ideas into practice. Enhanced Recovery After Surgery (ERAS) Pathways are coordinated, multidisciplinary perioperative care plans combining individual evidence-based elements of perioperative care, each of which may have modest benefits when used alone, into a coordinated effort that has a synergistic beneficial effect on surgical outcomes. ERAS programs encompass preoperative, intraoperative and postoperative phases. Principal elements include: 1. Preoperative patient education and preparation for surgery; 2. Anesthetic, analgesic and surgical techniques that decrease the surgical stress response, pain and discomfort and postoperative nausea and vomiting; 3. Aggressive postoperative rehabilitation. The aim of the program is to allow for pain and stress-free surgery with reduced complications, faster recovery and to increase patient autonomy and empowerment to participate in their care. At the McGill University Health Centre (MUHC), the Surgical Recovery (SURE) Work Group was created to develop and implement ERAS pathways across the department of surgery. The goal was to make the ERAS approach the standard of care for the most prevalent in-patient procedures across the surgical divisions, creating the pathways de novo based on evidence and adopted to local circumstances. ERAS pathways have been created and implemented in general surgery (colorectal, thyroidectomy, cholecystectomy, hernia), thoracic surgery (esophageal and lung resection) and urology (prostatectomy). The goals of the program are to: • Adhere to evidence-based practices in perioperative care for prevalent procedures in our department across multiple divisions • Improve patient recovery (monitored by hospital stay) without increasing readmissions • Improve efficiency (measured by length of stay for patients without complications and cost) • Decrease unwanted variability between practitioners • Ensure patient acceptance (measured by survey). The implementation of the ERAS care system has resulted in better organized care, decreased variability between practitioners and increased efficiency. They have been well accepted by clinicians and have increased interdisciplinary work in perioperative care.