Enhanced recovery after surgery (ERAS) and optimizing perioperative care: therapeutic updates, best practices, and barriers to care (CME)

Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to attenuate the stress response during a patient’s surgical procedure and preserve organ function while promoting early recovery. While this approach is not new, it has not always been widely employed in spite of supporting evidence from a range of randomized controlled trials, systematic reviews, and meta-analyses. This literature suggests that ERAS programs are safe, cost-effective, and minimize the length of stay in a hospital without compromising quality of care. ERAS programs are successful in part because they are proactive in nature, comprised of interventions beginning during preoperative planning and continuing through intraoperative management and postpostoperative care.

Objectives:

1. List the primary components of optimal ERAS programs
2. Describe strategies to in ERAS programs to optimize gastrointestinal recovery and apply them to patient cases
3. Describe optimal pain management strategies in ERAS programs and apply them to patient cases
4. Summarize the challenges facing the adoption of ERAS programs and discuss strategies to ameliorate them