ERAS ~ Enhanced Recovery After Surgery
I love it when I can say, “I learned something new today” and last week it was about ERAS, Enhanced Recovery After Surgery. I was having a conversation with the plastic surgeon who performed my DIEP flap breast reconstruction, Dr. Minas Chrysopoulo. I asked him if there were new protocols or changes in patient care during recovery in the two years since my DIEP flap surgery. A smile came across his face and I could tell he couldn’t wait to tell me about ERAS. He eloquently told me about the philosophy and implementation of this protocol and I was captivated. It must have been the look of complete amazement on my face because he smiled and said, “You should write a blog about it.” Nothing like a little challenge from a world class micro-surgeon to bequeath a bit of pressure for my next writing assignment!
I really can’t do justice to this topic so I want to share some segments in a recent article from the Journal of the American Medical Association (JAMA) about this very topic. Dr. C, as his patients refer to him, informed me that PRMA, the plastic surgery group he works with in San Antonio, is implementing some of the very protocols used in ERAS and with notable success.
From the article in JAMA Surg. Published online January 11, 2017.
Importance Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings.
Observations Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence.
The article went on to detail some of the changes that have been implemented including:
…evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis.
The protocol and practice of ERAS began mainly in colorectal surgery but is now being used in almost all major surgery specialties and is shown to improve outcomes.
A message I want to share with readers about ERAS:
Not every plastic surgery group or hospital is implementing this protocol. Change takes time. Implementation of new protocols like ERAS must be adopted, understood, and implemented by the practice or facility using it. My message: Ask when you go for your consult with your plastic surgeon if they are using it or if they have even heard of ERAS. Take this article with you so you can show them the details discussed in the JAMA article. They may, at the very least, be using parts of the protocol and even if they are not, you will be educating them about ERAS.
Thanks Dr. C for teaching me something new!
Educators love to learn!
Thanks to you and Dr. C. for this fantastic info. My sister recently had a lumpectomy – without a drain tube. I had never heard of this before but this is awesome. If you ask me, it is the single most important advancement in treatment based upon my personal experiences.
Hi Barbara. Thanks so much for your comment. I learn a great deal from Dr. C. I hope your sister is doing well. I really enjoy your posts. I feel so fortunate to be connected to individuals who are engaged with the breast cancer and breast reconstruction community.