Enhanced Recovery After Surgery (ERAS)

Frequently Asked Questions About ERAS

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Many patients have questions about the Enhanced Recovery After Surgery (ERAS) program. The following questions are addressed in the informational video below:

What does it mean to have a team approach?

Often in medicine, hospital care can be fragmented. If you’ve been a patient before, you might have experienced this and thought that the whole process is somewhat inefficient. You have multiple consultants who deal with you directly who don’t actually communicate with each other that often. 

That's something we target with our ERAS program at UT Southwestern. We've partnered with multiple members of your care team to try to improve communication and to evaluate the best evidence-based practices for your surgical care. It's through this collaboration that we came to create our ERAS protocols. The team includes surgeons, anesthesiologists, nurses, physical therapists, occupational therapists, and pharmacists all centered around you, the patient. 

We work diligently to develop and implement these protocols together so that we can all be on the same page and have the same goals in mind when it comes to your surgical care. We hope these protocols can make your care streamlined from beginning to end and provide the best possible surgical outcomes for your surgery.

I’ve always heard that I could not eat or drink anything the night before surgery. Is that different with ERAS pathways?

Yes. Under conventional medical care or surgical care, patients are asked to not drink or eat anything at midnight before their surgery, even if that surgery may be 10 or 12 hours later. With ERAS, we do ask that you not eat any food after midnight, but we do allow you to drink clear fluids, such as water, Gatorade, Sprite, even black coffee with no cream or sugar. We allow you to drink those to your comfort level up until two hours prior to your surgery. Many patients in the ERAS program are also asked to drink carbohydrate-rich drinks, such as Gatorade.

The clear fluids that you're allowed to drink serve a couple of purposes. First, they keep you more comfortable. Instead of having to wait 10 or 12 hours to have anything to drink, we allow our patients to drink those fluids up until two hours before, and they come into surgery more comfortable. Second, it keeps our patients more hydrated.

The carbohydrate-rich drinks serve a different purpose. It’s like running a marathon. The night before a race, marathon runners often “carb load” to get their bodies ready for the stress they're going to experience during the race. We're doing the same thing for our patients. We're getting you ready for the stress your body is going to experience during the surgery. All these recommendations are in line with our National Anesthesia Society guidelines. In general, the goal is to be safe but also to keep you comfortable and optimistic heading into your surgery.  

I’m worried about having to take narcotics during and after surgery, but I also don’t want to be in pain. How do ERAS pathways treat my surgical pain?

Narcotics, or opioids, are becoming a major problem in the United States. Aside from the serious issues of dependence and addiction, opioids have many other unwanted side effects after surgery, such as constipation, nausea, and itching. As such, physicians are striving to decrease the amount of opioids used in our surgical patients. 

This is true in our ERAS program. We focus on maximizing the use of other medications that target different mechanisms of pain. You will likely still need some short-acting narcotics during your hospitalization, since when used appropriately, these can be very effective at treating your surgical pain. But the mainstay of our plan actually includes scheduled non-narcotic medications, such as anti-inflammatory drugs or muscle relaxers. 

We also advocate for the use of regional anesthetic techniques, otherwise known as nerve blocks. This is similar to when the dentist injects local anesthetic medication around your tooth prior to a dental procedure. The nerve blocks that we perform, though, are done near your surgical incision site. They can effectively numb pain for 12 to 18 hours after your surgery, thus decreasing the amount of oral and intravenous (IV) pain medications that you may need. These methods, along with short-acting narcotics when necessary, comprise what we call multi-modal analgesia, which basically means that we use multiple ways to treat your pain and try to make you as comfortable as possible after surgery. 

How important is it that I am actively involved in my perioperative care? How do I make sure I keep up with my progress?

The ERAS program is really a partnership between you and your perioperative care team. Having a successful surgery and quick recovery depends on your participation in both the design and the follow-through of your unique surgical plan. You'll have preoperative visits with both your surgeon and anesthesiologists, and at these visits they’ll educate you about the process and set expectations – things we expect you to do along the way to be successful. 

It's key that our patients start planning and working toward their goals before ever arriving for surgery. After surgery, we ask that you adhere to the plan, including doing activities such as walking daily, staying hydrated, and continuing to take scheduled medications as prescribed. It's very important you communicate with both your physicians and your nurses every day, asking them what your goals are for those days so that you can accomplish them. By remaining active and attentive throughout this process, you increase the odds of having a successful surgery, recovery, and return to your base line health. 

What is expected of me after surgery? Why is activity important after surgery?

Preparation for surgery and the surgery itself are obviously important events in your care, but the real work actually begins after surgery. The postoperative phase of your care is crucial to both your short-term and your long-term recovery. Much of this will actually depend on your willingness and enthusiasm to participate daily in your care.

We do have some expectations of you to help ensure a successful hospitalization and recovery. We will do our part to try to treat your pain as adequately as possible, so that you will actually feel strong enough to increase your daily activity from hospitalization through discharge, and out of the hospital as well. We expect on your first postoperative day that you take multiple walks around the surgical unit. This may sound like the last thing you want to do after surgery, but you will have the assistance of the nursing staff and a physical therapist to help you achieve this goal. 

Walking is vital for several reasons. It improves your lung function, helps your intestines work again, improves your intestinal function, and prevents the formation of blood clots in your legs. 

Additionally, we hope that you can maintain your own hydration and nutrition after surgery. We want you to be able to eat and drink as much as you can tolerate, as directed by your surgical team. Nutrition and hydration are important for your recovery and ensure proper wound healing. If you can meet the goals of walking and increasing your activity every day, and maintaining your own hydration and nutrition, our expectation is that you'll have a short hospitalization and quick recovery, and we can get you back to your baseline health as quickly as possible.

What happens if I’m not ready to go home on my planned day of discharge?

When your surgeon meets with you before surgery, he or she will discuss the typical length of stay for the surgery you're having and how an ERAS plan may help you return home more quickly. Because we want you to be an active participant in your care, we ask that you give feedback along the way to help guide a safe discharge. You need to be able to do activities such as walking, so that when you get home, you can go to the kitchen, or get to the bathroom safely. We want your pain to be well controlled. We want you to be able to stay hydrated and keep your nutrition up. We want your wound to be healing properly. 

If, on the day of planned discharge, you or your physicians don't feel like you're ready to go home, that's okay. At that point, we’ll continue to work toward improving your health and condition. Our goal is to safely get you through that acute phase after surgery and to get you home to finish healing. Above all, your safety and comfort are our priorities while meeting these goals.

About the ERAS Program

Austin Street, M.D., and Jennifer Elia, M.D., address questions about the Enhanced Recovery After Surgery (ERAS) program at UT Southwestern.