Q&A About Enhanced Recovery After Surgery

Orthopedic surgeon Michael Mason, DO, explains how advances in caring for patients before, during, and after surgery lead to a faster recovery.

Lifespan orthopedic surgeon Michael Mason, DO.What does “enhanced recovery after surgery” (ERAS) mean?

Enhanced recovery after surgery (ERAS) is a highly effective approach to helping the patient prepare for, tolerate, and recover from their operation. It takes a holistic view of the case, optimizing the patient’s health before surgery, taking new approaches to anesthesia and pain relief, and getting the patient back on their feet quickly after the operation. 

How was the ERAS system developed? 

The ERAS protocol was developed in Europe in 2001 and has been adopted in more than 20 countries. It was first used with colorectal surgery cases but has been shown to improve outcomes in a broad range of surgeries.

In decades past, people would walk into the hospital in a healthy condition for elective surgery. Then we would operate, and they had to be hospitalized to recover from the procedure’s side effects, as well as the procedure itself. With ERAS, patients go into surgery better prepared physically and mentally, suffer fewer side effects, and recover more quickly.

How do you apply ERAS in your orthopedic surgery practice?

It starts with patient and family education about the surgery and what to expect as they move through the ERAS process.

We emphasize physical and mental optimization before admission. A physical therapist assesses the patient and might recommend cardiac rehabilitation or pulmonary rehabilitation to build endurance, in addition to muscle-strengthening exercises.

As part of prehab, we get patients accustomed to working with the European (cuff) crutches they’ll be using during their recovery. These allow a normal, reciprocal gait, unlike traditional crutches.

We begin a three-pronged approach to pain relief two days ahead of the surgery to proactively reduce inflammation. This helps us avoid prescribing opioids for pain control after surgery.

Because we use regional instead of general anesthesia, there’s no need for fasting before surgery. Patients have a complex carbohydrate drink the night before surgery and may have clear liquids up to two hours before, so they don’t go into the operating room hungry or dehydrated. They return to a normal diet and get up and around within hours of their surgery, and usually go home the next day.

How does ERAS benefit the patient?

Shorter hospital stays, quicker recovery, reduced incidence of complications and readmissions, and lower costs are all benefits of the ERAS protocol. The goals are to diminish the impact of surgery on the body, minimize stress, treat pain proactively, and expedite the patient’s return to daily activities.

Our patients get up and start walking two hours after surgery, which helps keep oxygen levels up and prevents deconditioning. While in the hospital, they use a special cold compression wrap called Game Ready, which helps reduce discomfort, swelling, and inflammation.

Most people do physical therapy twice the day of surgery, once the next morning, and then they go home to recuperate with some assistance from family, friends, or visiting nurses. Patients continue with physical therapy on an outpatient or at-home basis.

Overall, the recovery period is shortened using ERAS. People are on crutches for one to two weeks, compared to an average of four to six weeks some years ago. They return to normal activities of daily living much faster, with much less pain.