Skip to main content

ERAS Position in the Global Surgical Community

  • Chapter
  • First Online:
Enhanced Recovery After Surgery

Abstract

Enhanced recovery after surgery (ERAS) presents a paradigm shift in perioperative care for an expanding range of surgical procedures. ERAS, also known as fast-track surgery or enhanced recovery program (ERP), was initially developed in academic institutions in Northern Europe. Over the last two decades, it has matured from a primarily European approach to perioperative care to an international evidence-based program to improve patient care. Today, ERAS is a constantly evolving field of medicine and is increasingly embraced by the global surgical community.

This chapter discusses how ERAS, initially popularized by Professor Henrik Kehlet, transitioned from academia to standard clinical care, as promoted by the initial founders of the ERAS® Society. The nature of ERAS in the global surgical community is described in a narrative fashion in both developed and developing nations. This chapter highlights the global collaboration efforts as well as the future of ERAS internationally.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Ljungqvist O, Young-Fadok T, Demartines N. The History of Enhanced Recovery After Surgery and the ERAS Society. J Laparoendosc Adv Surg Techn. 2017;27(9):860–2.

    Article  Google Scholar 

  2. Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg. 1999;86(2):227–30.

    Article  CAS  PubMed  Google Scholar 

  3. Ljungqvist O. ERAS—Enhanced Recovery After Surgery. J Parenter Enter Nutr. 2014;38(5):559–66.

    Article  Google Scholar 

  4. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery a review. JAMA Surg. [Review]. 2017;152(3):292–8.

    PubMed  Google Scholar 

  5. Ljungqvist O. ERAS–enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr. 2014;38(5):559–66.

    Article  PubMed  Google Scholar 

  6. Bardram L, Funch-Jensen P, Jensen P, Kehlet H, Crawford M. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet. 1995;345(8952):763–4.

    CAS  PubMed  Google Scholar 

  7. ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg. 2015;261(6):1153–9.

    Article  Google Scholar 

  8. Lassen K, Hannemann P, Ljungqvist O, Fearon K, Dejong CHC, von Meyenfeldt MF, et al. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ. 2005;330(7505):1420–1.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gillissen F, Hoff C, Maessen JM, Winkens B, Teeuwen JH, von Meyenfeldt MF, et al. Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in The Netherlands. World J Surg. 2013;37(5):1082–93.

    Article  PubMed  Google Scholar 

  10. Gillissen F, Ament SMC, Maessen JMC, Dejong CHC, Dirksen CD, Van Der Weijden T, et al. Sustainability of an Enhanced Recovery After Surgery program (ERAS) in colonic surgery. World J Surg. [Article]. 2015;39(2):526–33.

    Article  CAS  PubMed  Google Scholar 

  11. Gillissen F, Hoff C, Maessen JMC, Winkens B, Teeuwen JHFA, Von Meyenfeldt MF, et al. Structured synchronous implementation of an enhanced recovery program in elective colonic surgery in 33 hospitals in the Netherlands. World J Surg. [Article]. 2013;37(5):1082–93.

    Article  PubMed  Google Scholar 

  12. Fearon KCH, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CHC, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466–77.

    Article  CAS  PubMed  Google Scholar 

  13. DH NI, NCAT, NHS Institute. Enhanced Recovery Partnership Project Report – March 2011. In: Care DoHaS, editor; 2011.

    Google Scholar 

  14. Knott A, Pathak S, McGrath JS, Kennedy R, Horgan A, Mythen M, et al. Consensus views on implementation and measurement of enhanced recovery after surgery in England: Delphi study. BMJ Open. [Article]. 2012;2(6).

    Google Scholar 

  15. Simpson JC, Moonesinghe SR, Grocott MPW, Kuper M, McMeeking A, Oliver CM, et al. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012†. Br J Anaesth. 2015;115(4):560–8.

    Article  CAS  PubMed  Google Scholar 

  16. Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149(6):830–40.

    Article  PubMed  Google Scholar 

  17. Paton F, Chambers D, Wilson P, Eastwood A, Craig D, Fox D, et al. Effectiveness and implementation of enhanced recovery after surgery programmes: a rapid evidence synthesis. BMJ Open. 2014. 07/22. 02/07/received. 07/01/revised. 07/04/accepted;;4(7):e005015.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alcántara-Moral M, Serra-Aracil X, Gil-Egea MJ, Frasson M, Flor-Lorente B, Garcia-Granero E. Observational cross-sectional study of compliance with the fast track protocol in elective surgery for colon cancer in Spain. Int J Colorectal Dis. [Article]. 2014;29(4):477–83.

    Article  PubMed  Google Scholar 

  19. Ruiz-Tovar J, Royo P, Muñoz JL, Duran M, Redondo E, Ramirez JM. Implementation of the Spanish National Enhanced Recovery Program (ERAS) in bariatric surgery: a pilot study. Surg Laparosc Endosc Percutan Techn. [Article]. 2016;26(6):439–43.

    Article  Google Scholar 

  20. Ruiz-Tovar J, Muñoz JL, Royo P, Duran M, Redondo E, Ramirez JM, et al. Implementation of the Spanish ERAS program in bariatric surgery. Minim Invasive Ther Allied Technol. [Article]. 2018;27(6):365–72.

    Article  PubMed  Google Scholar 

  21. Ripollés-Melchor J, Casans-Francés R, Abad-Gurumeta A, Suárez-de-la-Rica A, Ramírez-Rodríguez JM, López-Timoneda F, et al. Spanish survey on enhanced recovery after surgery. Rev Esp Anestesiol Reanim. [Article]. 2016;63(7):376–83.

    Article  PubMed  Google Scholar 

  22. Slim K, Delaunay L, Joris J, Léonard D, Raspado O, Chambrier C, et al. How to implement an enhanced recovery program? Proposals from the Francophone Group for enhanced recovery after surgery (GRACE). J Visc Surg. [Article]. 2016;153:S45–S9.

    Article  CAS  PubMed  Google Scholar 

  23. Veziant J, Slim K, Veziant J, Raspado O, Entremont A, Joris J, et al. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg. [Article]. 2017;154(3):159–66.

    Article  CAS  PubMed  Google Scholar 

  24. Faujour V, Slim K, Corond P. The future, in France, of enhanced recovery after surgery seen from the economical perspective. Presse Med. [Article]. 2015;44(1):e23–31.

    Article  PubMed  Google Scholar 

  25. Kehlet H, Buchler MW, Beart RW Jr, Billingham RP, Williamson R. Care after colonic operation–is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg. 2006;202(1):45–54.

    Article  PubMed  Google Scholar 

  26. Liu VX, Rosas E, Hwang J, Cain E, Foss-Durant A, Clopp M, et al. Enhanced Recovery After Surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg. 2017;152(7):e171032.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Stone AB, Grant MC, Pio Roda C, Hobson D, Pawlik T, Wu CL, et al. Implementation costs of an Enhanced Recovery After Surgery program in the United States: a financial model and sensitivity analysis based on experiences at a quaternary academic medical center. J Am Coll Surg. 2016;222(3):219–25.

    Article  PubMed  Google Scholar 

  28. Lee L, Mata J, Ghitulescu GA, Boutros M, Charlebois P, Stein B, et al. Cost-effectiveness of enhanced recovery versus conventional perioperative management for colorectal surgery. Ann Surg. 2015;262(6):1026–33.

    Article  PubMed  Google Scholar 

  29. Roulin D, Donadini A, Gander S, Griesser AC, Blanc C, Hübner M, et al. Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery. Br J Surg. 2013;100(8):1108–14.

    Article  CAS  PubMed  Google Scholar 

  30. Sammour T, Zargar-Shoshtari K, Bhat A, Kahokehr A, Hill AG. A programme of Enhanced Recovery After Surgery (ERAS) is a cost-effective intervention in elective colonic surgery. N Z Med J. [Online]. 2010;123(1319):61–70.

    PubMed  Google Scholar 

  31. Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430–43.

    Article  PubMed  Google Scholar 

  32. Miller TE, Thacker JK, White WD, Mantyh C, Migaly J, Jin J, et al. Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol. Anesth Analg. 2014;118(5):1052–61.

    Article  PubMed  Google Scholar 

  33. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374(2):154–63.

    Article  CAS  PubMed  Google Scholar 

  34. Stone AB, Wick EC, Wu CL, Grant MC. The US opioid crisis: a role for Enhanced Recovery After Surgery. Anesth Analg. [Short Survey]. 2017;125(5):1803–5.

    Article  PubMed  Google Scholar 

  35. Brandal D, Keller MS, Lee C, Grogan T, Fujimoto Y, Gricourt Y, et al. Impact of enhanced recovery after surgery and opioid-free anesthesia on opioid prescriptions at discharge from the hospital: a historical-prospective study. Anesth Anal. [Review]. 2017;125(5):1784–92.

    Article  Google Scholar 

  36. Kim MP, Chan EY, Meisenbach LM, Dumitru R, Brown JK, Masud FN. Enhanced recovery after thoracic surgery reduces discharge on highly dependent narcotics. J Thorac Dis. 2018;10(2):984.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Thanh NX, Chuck AW, Wasylak T, Lawrence J, Faris P, Ljungqvist O, et al. An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta. Can J Surg. 2016;59(6):415.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Nelson G, Kiyang L, Chuck A, Thanh N, Gramlich L. Cost impact analysis of Enhanced Recovery After Surgery program implementation in Alberta colon cancer patients. Curr Oncol. 2016;23(3):e221.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Nelson G, Kiyang LN, Crumley ET, Chuck A, Nguyen T, Faris P, et al. Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: the ERAS Alberta colorectal surgery experience. World J Surg. 2016;40(5):1092–103.

    Article  PubMed  Google Scholar 

  40. AlBalawi Z, Gramlich L, Nelson G, Senior P, Youngson E, McAlister FA. The impact of the implementation of the Enhanced Recovery After Surgery (ERAS®) program in an entire health system: a natural experiment in Alberta, Canada. World J Surg. [Article]. 2018;42(9):2691–700.

    Article  PubMed  Google Scholar 

  41. Gramlich LM, Sheppard CE, Wasylak T, Gilmour LE, Ljungqvist O, Basualdo-Hammond C, et al. Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system. Implement Sci. 2017;12(1):67.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Zargar-Shoshtari K, Connolly AB, Israel LH, Hill AG. Fast-track surgery may reduce complications following major colonic surgery. Dis Colon Rectum. 2008;51(11):1633–40.

    Article  PubMed  Google Scholar 

  43. Stowers MDJ, Manuopangai L, Hill AG, Gray JR, Coleman B, Munro JT. Enhanced Recovery After Surgery in elective hip and knee arthroplasty reduces length of hospital stay. ANZ J Surg. 2016;86(6):475–9.

    Article  PubMed  Google Scholar 

  44. Proudfoot S, Bennett B, Duff S, Palmer J. Implementation and effects of Enhanced Recovery After Surgery for hip and knee replacements and fractured neck of femur in New Zealand orthopaedic services. N Z Med J. 2017;130(1455):77–90.

    PubMed  Google Scholar 

  45. Health Mo. A review of the national orthopaedic Enhanced Recovery after Surgery (ERAS) quality improvement collaborative: November 2013–March 2015. In: Health Mo, editor. Wellington; 2017.

    Google Scholar 

  46. Christelis N, Wallace S, Sage CE, Babitu U, Liew S, Dugal J, et al. An enhanced recovery after surgery program for hip and knee arthroplasty. Med J Aust. [Article]. 2015;202(7):363–9.

    Article  PubMed  Google Scholar 

  47. Tan NLT, Hunt JL, Gwini SM. Does implementation of an enhanced recovery after surgery program for hip replacement improve quality of recovery in an Australian private hospital: a quality improvement study. BMC Anesthesiol. [Article]. 2018;18(1):64.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Thompson EGE, Gower ST, Beilby DS, Wallace S, Tomlinson S, Guest GD, et al. Enhanced Recovery After Surgery program for elective abdominal surgery at three Victorian hospitals. Anaesth Intensive Care. [Article]. 2012;40(3):450–9.

    Article  CAS  PubMed  Google Scholar 

  49. Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan. BMC Surg. [Journal Article]. 2015;15(1):90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg. [Journal Article]. 2017;17(1):18.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Nanavati AJ, Nagral S. Why have we embraced minimally invasive surgery and ignored enhanced recovery after surgery? J Minim Access Surg. 2016;12(3):299.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Abdikarim I, Cao XY, Li SZ, Zhao YQ, Taupyk Y, Wang Q. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol. [Article]. 2015;21(47):13339–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Ren L, Zhu D, Wei Y, Pan X, Liang L, Xu J, et al. Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg. [Review]. 2012;36(2):407–14.

    Article  CAS  PubMed  Google Scholar 

  54. Nanavati AJ, Nagral S, Prabhakar S. Fast-track surgery in India. Natl Med J India. 2014;27(2):79–83.

    PubMed  Google Scholar 

  55. Biccard BM, Alphonsus CS, Bishop DG, Cronje L, Kluyts HL, Kusel B, et al. National priorities for perioperative research in South Africa. S Afr Med J. [Article]. 2016;106(5):485–8.

    Article  Google Scholar 

  56. Oodit RL, Ljungqvist O, Moodley J. Can an enhanced recovery after surgery (ERAS) programme improve colorectal cancer outcomes in South Africa? S Afr J Surg. [Note]. 2018;56(1):8–11.

    Article  CAS  PubMed  Google Scholar 

  57. Loots E, Sartorius B, Paruk IM, Clarke DL. The successful implementation of a modified Enhanced Recovery After Surgery (ERAS) program for bariatric surgery in a South African teaching hospital. Surg Laparosc Endosc Percutan Tech. 2018;28(1):26–9.

    Article  PubMed  Google Scholar 

  58. de Aguilar-Nascimento JE, Bicudo-Salomão A, Caporossi C, Silva RM, Cardoso EA, Santos TP. Enhancing surgical recovery in Central-West Brazil: The ACERTO protocol results. E SPEN Eur E J Clin Nutr Metab. 2008;3(2):e78–83.

    Article  Google Scholar 

  59. Bicudo-Salomao A, Meireles MB, Caporossi C, Crotti PL, de Aguilar-Nascimento JE. Impact of the ACERTO project in the postoperative morbi-mortality in a university hospital. Revista do Colegio Brasileiro de Cirurgioes. 2011;38(1):3–10.

    Article  PubMed  Google Scholar 

  60. Alito MA, de Aguilar-Nascimento JE. Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study. Nutr J. 2016;15:34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Nygren J, Thacker J, Carli F, Fearon KCH, Norderval S, Lobo DN, et al. Guidelines for perioperative care in elective rectal/pelvic surgery: Enhanced Recovery After Surgery (ERAS®) society recommendations. World J Surg. 2013;37(2):285–305.

    Article  CAS  PubMed  Google Scholar 

  62. Elias KM, Stone AB, McGinigle K, Tankou JAI, Scott MJ, Fawcett WJ, et al. The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies. World J Surg. [Journal Article]. 2019;43(1):1–8.

    Article  PubMed  Google Scholar 

  63. McQueen K, Oodit R, Derbew M, Banguti P, Ljungqvist O. Enhanced Recovery After Surgery for Low- and Middle-Income Countries. World J Surg. [Journal Article]. 2018;42(4):950–2.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Weisi Xia .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Xia, W., Barazanchi, A.W.H., Hill, A.G. (2020). ERAS Position in the Global Surgical Community. In: Ljungqvist, O., Francis, N., Urman, R. (eds) Enhanced Recovery After Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-33443-7_65

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-33443-7_65

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-33442-0

  • Online ISBN: 978-3-030-33443-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics