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Enhanced recovery after surgery: Improving outcomes and empowering patients

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A new standard of care is transforming surgical outcomes at VCU Health and around the world.

ERAS – the Enhanced Recovery After Surgery program – is a bundle of measures taken before, during and after surgery to speed patient recovery and reduce pain, minimizing the use of opioids and the risk of complications.

ERAS originated in Europe about 15 years ago. At VCU Medical Center, Michael Scott, M.D., director of critical care anesthesiology, was a pioneer of the program and now spearheads the ERAS program here. “ERAS does not actually change the surgical procedure itself, but changes what happens to the patient around the time of surgery – before, during and after,” he says.

General principles of ERAS include optimizing patient health prior to surgery, limiting unnecessary medical interventions, reducing opioid administration, as well as getting patients up and about, free of IV drips and drainage tubes as soon as possible.

 

Before surgery

Through ERAS, patients undergo a thorough evaluation to identify and address coexisting conditions and risk factors prior to the surgery.

“We start by reviewing the patient, optimizing all their comorbid healthcare conditions. We optimize diabetes, improve anemia and blood pressure control, and get that all sorted out prior to surgery rather than just getting them straight into surgery,” explains Scott. “The analogy is: you wouldn’t get in a plane and fly across the Atlantic without making sure the engines work, there’s enough fuel in the tanks, and you know which direction you’re heading.”

At VCU Health, this takes place at the preoperative clinic, or the PACE Center, where patients see a specialist provider.

The ERAS surgical pathway

The underlying thread in ERAS is that all parties involved – from care team members across a variety of disciplines to the patients themselves – have an in-depth understanding of what is happening each step of the way.

In the operating room, the surgical team takes a series of measures to ensure a safe and faster recovery. For instance, core body stability is maintained using short-acting anesthetics, managing blood pressure, reducing nausea and vomiting, and keeping patients warm.

Similar measures are taken in postoperative care to help ensure optimal recovery. “We keep optimizing them to make sure they are ready to go to the [recovery] floor – making any small changes needed – so we know the patient is going to be stable and make a good recovery,” Scott shares.

The morning after surgery is considered a “de-escalation of care” period, when IV drips are typically taken down, catheters are removed and patients begin eating. “They are made free of all the other things that otherwise would keep them in bed and disrupt their physiology,” Scott says.

The standard of surgical care

With proven success rates in patient recovery and overall outcomes, ERAS is becoming the standard in surgical interventions.

“Wherever you are in the world, if ERAS is implemented, there’s always a reduction in the length of stay. But, the emphasis should not be on length of stay,” Scott says. “It’s on improved, faster recovery to baseline. That’s really where the benefit is for the patient. [ERAS’ implementation] is something that does not cost very much money, empowers patients, reduces complications, and is good news for everyone.”

Listen to a full interview with Scott on this topic by clicking here. For more episodes, find the Healthy with VCU Health podcast on any major streaming platform or by visiting the VCU Health Podcast library at vcuhealth.org/podcasts.