Enhanced Recovery After Surgery (ERAS) is an evolving concept of optimising the recovery of patients after surgery.  We have been practicing these principles in addition to our other rapid recovery surgery concepts (including LIA).

ERAS includes: education of patients prior to surgery, minimising fasting (we ask our patients to drink a sports drink two hours before surgery), avoiding drains, avoiding opioids, and creating an environment that is easy for the patient to mobilise early. Avoiding nausea for whatever reason is critical to allow mobilisation.

A large series from Khan (n=6000) demonstrated a reduction in 30-day mortality (0.1% v 0.5% p=0.03) and a reduction in myocardial infarction (0.4% v 0.9% p=0.03). The mechanism of these reductions is not yet clear, but aspirin rather than traditional anticoagulants probably infers a cardiac advantage.

Our average length of stay (1.7 days, 70% of patients go home on day 1), is substantially faster than the authors of the recent editorial, but we remain committed to Rapid Recovery Surgery, and are heartened to see proof that early mobilisation and early discharge from hospital improved patients outcomes.

References:
Stowers et al, ANZ J Surg 2016; 86: 327-328
Khan SK et al, Acta Orthop 2014; 85: 26-31

Mr David Mitchell