Enhanced Recovery After Surgery Protocols

Enhanced recovery after surgery (ERAS) protocols are multimodal approaches to the perioperative care of the surgical patient and represent a paradigm shift in the multidisciplinary approach to surgical recovery. For decades, ERAS principles have been aimed at reducing the surgical stress response and rapid return to homeostasis, leading to improved perioperative outcomes for surgical patients across many disciplines. Well-documented benefits of ERAS include reduced complications and length of stay; however, benefits may extend beyond the immediate postoperative period. Core components of ERAS include the “four pillars” essential to these protocols, including early feeding, early ambulation, goal-directed fluid therapy, and opiate-sparing analgesia. In this chapter, a brief description of the evolution of ERAS will be presented, as well as documented examples of the impact of these approaches on surgical safety and efficiency. Finally, a detailed discussion of the core components, and other fast-track principles, will be presented.