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Review
. 2018 Apr-Jun;14(2):77-88.
doi: 10.14797/mdcj-14-2-77.

The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery

Jessica K Brown  1 , Karanbir Singh  1 , Razvan Dumitru  1 , Edward Chan  1 , Min P Kim  1
Affiliations
Review

The Benefits of Enhanced Recovery After Surgery Programs and Their Application in Cardiothoracic Surgery

Jessica K Brown et al. Methodist Debakey Cardiovasc J. 2018 Apr-Jun.

Abstract

The perioperative care of the surgical patient is undergoing a paradigm shift. Enhanced Recovery After Surgery (ERAS) programs are becoming the standard of care and best practice in many surgical specialties throughout the world. ERAS is a multimodal, multidisciplinary, evidence-based approach to care of the surgical patient that aims to optimize perioperative management and outcomes. Implementation, however, has been slow because it challenges traditional surgical doctrine. The key elements of ERAS Pathways strive to reduce the response to surgical stress, decrease insulin resistance, and maintain anabolic homeostasis to help the patient return to baseline function more quickly. Data suggest that these pathways have produced not only improvements in clinical outcome and quality of care but also significant cost savings. Large trials reveal an increase in 5-year survival and a decrease in immediate complication rates when strict compliance is maintained with all pathway components. Years of success using ERAS in colorectal surgery have helped to establish a body of evidence through a number of randomized controlled trials that encourage application of these pathways in other surgical specialties.

Keywords: ERAS; cardiothoracic surgery; enhanced recovery after surgery; length of stay; lung resection; multimodal analgesia; transcatheter aortic valve replacement.

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Conflict of interest statement

Conflict of Interest Disclosure: Dr. Brown's spouse is on the board of directors for RAMSES (robotic assisted microsurgical and endoscopic surgery). Dr. Kim is on the speakers' bureau for Olympus, Medtronics, Intuitive Surgical, Boston Scientific. Dr. Chan is a consultant for Medtronic, Ethicon, and Boston Scientific.

Figures

Figure 1.
Figure 1.
Effects of stress response on whole body protein catabolism. Reprinted with permission.
Figure 2.
Figure 2.
Preoperative, intraoperative, and postoperative components of an ERAS pathway.
See this image and copyright information in PMC

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