ERAS Sandra J. Beck, MD, FACS, FASCRS Section Chief, Colon and Rectal Surgery Associate Professor of Surgery University of Kentucky

ERAS – What is it? Enhanced Recovery After Surgery Started by a Danish Surgeon Applied more widely in Europe because of the Great Recession. Multi-D approach to the Perioperative Care of the patient that challenges traditional Surgical practice Who – General Surgery, Colon and Rectal, Ob/Gyn, Urology, Thoracic Surgery, Orthopedics

Overall Goals Patient centered care focused on elective surgery Reduce surgical stress Reduce length of stay Reduce complications Empowers the patient to participate in their care

Before Surgery Evaluation of the patient focuses on: Health screening for potential causes of increased morbidity that may be optimized: Anemia, Diabetes control, poor nutrition, hypertension, reduced renal function, obesity Are they a candidate for minimally invasive approach? Estimating surgical risk: Can they drink fluids before surgery Risk of significant blood loss

NPO after midnight Promotes insulin resistance Patient comes to the OR starving and dehydrated More fluid shifts in the operating room Who can we let drink for longer BMI < 35 Not diabetic No significant GERD No bowel obstruction

Pre OP Pep Talk Introduce the patient to the care team even if it is just a list. Stress the importance of getting out of bed as fast as possible Introduce the idea that many different drugs or regional pain modalities may be used to control their pain and decrease the focus on narcotics Introduce the criteria for discharge.

Peri-operative Care Dr. Rebel will discuss. Requires a dedicated team

Post operative care Early feeding – sometimes even in the PACU Skip clear liquids if possible Early ambulation – the day of surgery they should be out of bed. Avoid oversedation Minimize tubes and drains Foley catheters out by day 2 if possible.

Why are we doing this Decrease the patients stress Faster return of bowel function Decrease length of stay Decrease in wound complications Decrease in anastomotic leak and deep space infection Save money? depends

Questions