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

2. 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

3. 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

4. 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

5. 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

6. 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.

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

8. 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.

9. 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

10. Questions