# ERAS® Society > ERAS® is a multimodal perioperative care pathway designed to achieve early recovery for patients undergoing major surgery. ## Posts ### Prof Mary Brindle - elected as Fellow by the Canadian Academy of Health Sciences   We are delighted to announce that Professor Mary Brindle, who is our Executive Secretary, has just been elected as a new Fellow by the Canadian Academy of Health Sciences. This is an absolutely wonderful achievement and is rightly recognised for all her hard work on surgical safety, health equity, advancing digital health as well as ERAS. As a society we are very proud. Congratulations Mary!           The Canadian Academy of Health Sciences (CAHS) is pleased to announce the 47 new Fellows elected for 2025. CAHS is proud to recognize excellence in health sciences and these new Fellows reflect a rich and varied expertise. “We congratulate all the applicants elected as Fellows to the Canadian Academy of Health Sciences for 2025. This recognition honors their dedication and excellence in their respective fields,” said Dr. Sylvie Nadeau, Chair of the Fellowship Committee. “We look forward to their expertise enriching the work of our Academy.” Election to Fellowship in the Academy is considered one of the highest honours for individuals in the Canadian health sciences community. It entails a commitment to serve the Academy and advance the health sciences across all of the Fellow’s disciplines.   “Election to the Canadian Academy of Health Sciences acknowledges outstanding contributions to the health sciences,” says Dr. Trevor Young, President, CAHS. “We are proud of these Fellows’ accomplishments, and we are honoured to welcome them to the Canadian Academy of Health Sciences.” ### International Surgical Society (ISS) Congress in 2026 Looking ahead, we encourage you to save the date for the ISS Congress in 2026. It is being held in Mexico on 19th to 23rd April 2026. The congress is a key global gathering for surgical leaders, and we hope to see strong representation from the surgical members of our ERAS community. Please click here for more details.       ### New 3 part guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC) published in World Journal of Surgery We are delighted to announce the publication of a three part guideline on the Enhanced Recovery After Trauma and Intensive Care (ERATIC). These are ERAS Society and International Association of Trauma Surgery and Intensive Care (IATSIC) recommendations. These consensus guidelines examine optimal pre-hospital, resuscitation-room, intra-, and post-operative treatment, systems of ethical management, and overall care for trauma patients in the post-resuscitation phase of care. Part 1  Initial care - Pre and Intraoperative care until ICU, including non-operative management Part 2 Postoperative and Intensive Care Recommendations Part 3 Trauma Ethics and System Aspects   ### Help needed for a 'patient voice project' *Call for help* Help needed for a 'patient voice project' for our upcoming World Congress. We are looking for feedback from patients who have gone through an ERAS pathway. Ideally we'd like short videos from patients telling us about their experience. If you can help please send us a message. Patients are obviously the most important part of the programme, and so we want to know more about their journey: did they feel well informed pre-op? Did they understand what ERAS was / why important? What was the most difficult part eg mobilisation? Did they feel supported on discharge? Did they have a dedicated ERAS nurse? What could we do differently / better? If you can help please get in touch. Thanks email: angie.balfour@erassociety.org ### New Colorectal ERAS Guidelines published in Surgery We are delighted to announce that our new updated guidelines for the preoperative care in elective Colorectal surgery have just been published open access in Surgery. These will also be presented at our upcoming world congress in Turin in September. Congratulations to all our authors and thank them for all their hard work. Click here to read the article. ### Early bird registration ending soon! Delighted to have  220 original ERAS abstracts accepted for the World Congress, scheduled for either oral and/or poster presentation. We are looking forward to meeting the authors and sharing their research with us.  Don't forget Early Bird registration finishes at the end of June!    https://erassociety.org/event/11th-eras-world-congress-september-17-19th-2025-turin-italy/ ### Online conference organised by the Taiwan ERAS Chapter: June 29th 2025   For more information use the QR codes or click here. ### Survey Assessing Prehabilitation Use in Major Abdominal Surgery Dear colleagues, on behalf of ESPEN (European Society for Clinical Nutrition and Metabolism) Special Interest Group on Nutrition in Surgery, we are invite you to participate in a scientific survey on prehabilitation use and implementation in major abdominal surgery. The main aims of this survey are assessment of the extent of prehabilitation adoption in surgical departments and to identify barriers and enablers to the implementation of prehabilitation. The data collected through this survey may help in further strategies for improvement the prehabilitation adoption in surgical settings.  The deadline for completing the survey is May 31, 2025, after which the online form will be closed. To start the Survey click here or scan the QR code below.   ### From Pilot to Policy: Taiwan Adopts ERAS as National Reimbursement for Value-Based Surgical Care Beginning in May 2025, Taiwan’s national reimbursement system will officially include Enhanced Recovery After Surgery (ERAS), marking a major step forward in patient-centered, value-based surgical care.  A pilot program conducted in Taipei last year demonstrated promising results, with notable reductions in surgical complications, shorter hospital stays, and significant cost savings. Building on this success, the ERAS program will now be expanded to hospitals across the country. The initiative is projected to benefit approximately 2,600 patients annually and is supported by a budget of NT$50 million (about US$1.6 million). The full rollout of ERAS reimbursement will span three years and incorporate all ERAS protocols. Taiwan ERAS Society Chairman Dr. Shu-Lin Guo emphasized that this initiative marks a milestone in developing a sustainable, value-driven model for elderly surgical care.  ### Keynote Speakers Announced for 11th ERAS World Congress in Turin We are delighted to confirm our three keynote speakers for the ERAS Society 11th World Congress, September 17th-19th 2025 in the Lingotto Conference Centre, Turin. ### 4th ERAS Asia-Pacific International Congress The 4th ERAS Asia-Pacific Congress held in Manila in November 2024. It was a truely landmark event in the realm of surgical care in the region, highlighting the significance of the Enhanced Recovery After Surgery (ERAS) protocols. The congress brought together over 270 healthcare professionals from 11 countries to delve into cutting-edge advancements in ERAS. This biennial congress underscored the growing international interest in optimizing surgical outcomes and recovery.     For the full write up, please click here ### Professor Gregg Nelson recognised for outstanding achievement by IGCS Dr. Gregg Nelson has been recognised for his outstanding acievment by the IGCS (International Gynecological Cancer Society) for his role in the development and study of Enhanced Recovery After Surgery (ERAS®) protocols in OB-Gyn and cancer surgery. He is Professor and Chair of Gynecologic Oncology at the Arthur J.E. Child Comprehensive Cancer Centre, University of Calgary, in Calgary, Alberta, Canada. Dr. Nelson was instrumental in bringing ERAS® to the gynecologic oncology discipline, as lead author of the ERAS® Society Guidelines for Gynecologic/Oncology published originally in 2016, followed by updates in 2019 and 2023. Dr. Nelson has been involved in numerous other ERAS® Society Guidelines including senior author for the cytoreduction/HIPEC guidelines and vulvar/vaginal surgery guidelines. He holds the positions of Physician Lead for ERASAlberta and Co-Chair of Enhanced Recovery Canada, along with previous roles as Secretary and Treasurer for the ERAS® Society. Dr. Nelson’s important role in the introduction and implementation of ERAS® protocols into gynecology (benign and malignant) and obstetrics (caesarean delivery) have earned him the IGCS Award for Outstanding Achievement in Gynecologic Oncology Surgery. His commitment to excellence, patient safety, quality care, and improved outcomes helped to forge a new path on which future generations of gynecologic surgeons will continue to build upon for the advancement of women’s health. For more info click here.   ### Innovative new ERAS ward introduced in Singapore Hospital Tan Tock Seng Hospital in Singapore have introduced a new ERAS Ward to help patients achieve early DrEaMing (Drinking, Eating and Mobilizing) after major surgeries. Features of this new ward include a walking track, pop up communal dining and activities areas, and nurses who are specially trained based on post operative ERAS care. Since starting this new initiative in February 2024, postoperative compliance to early oral nutrition and mobilisation have more than doubled, with further reduction in length of stay. Every effort counts in ERAS. Click here for more details   ### 4th ERAS Asia-Pacific International Congress "Improving Patient Care Through ERAS in Asia-Pacific" We are delighted to announce the 4th ERAS Asia-Pacific International Congress. Entitled "Improving Patient Care Through ERAS in Asia-Pacific". It will be held on November 14th and 15th 2024 in Manila, Philippines. To register click here.   For any further details please email: erasasia2024@gmail.com   ### Global Perceptions on ERAS in Pancreatoduodenectomy Uptake of ERAS pathways for pancreatic surgery have been slow and impacted by low compliance. To explore global awareness, perceptions and practice of ERAS  peri-pancreatoduodenectomy (PD), a structured, web-based survey (EPSILON) was administered through the ERAS society and IHPBA membership. There were 140 respondants. Reduced medical complications, cost and hospital length of stay, and improved patient satisfaction were the perceived benefits of compliance to enhancing-recovery. Multidisciplinary co-ordination was considered the most important factor in the implementation and sustainability of peri-PD ERAS  pathways, while reluctance to change among health care practitioners, difficulties in data collection and audit, lack of administrative support, and recruitment of an ERAS  dedicated nurse were reported to be important barriers. The EPSILON survey highlighted global clinician perceptions regarding the benefits of compliance to peri-PD ERAS, the importance of individual components, perceived facilitators and barriers, to the implementation and sustainability of these pathways. To read the paper click here. ### Professor Dileep Lobo - double award winner Professor Dileep Lobo, Chair of the Scientific Committee of the ERAS Society delivered the Sir David Cuthbertson Oration at the 45th Congress of the European Society for Clinical Nutrition and Metabolism at Lyon, France on 12 September 2023. He was honoured for his body of work on perioperative fluid and electrolyte therapy. The title of his lecture was “A Fluid Journey: Experiments that Changed Clinical Practice”. Click here to read the associated paper. The award is conferred for high quality work that has made a difference to the science of metabolism and nutrition. Previous recipients of the award can be found here.       He was also awarded the Association Award by the Association of Anaesthetists of Great Britain and Ireland on 15 September 2023 for his contributions to perioperative care, including fluid therapy, enhanced recovery after surgery and perioperative opioid use. The Association Award is awarded to anaesthetists and other individuals who have made significant contributions to the Association of Anaesthetists and its charitable foundation, its objects and goals, or its members.   Both these awards are testiment to Dileeps hard work and dedication to the field of perioperative medicine and of course ERAS. As a society we are exceptionally proud that one of our own has been recognised with these two prestigious awards.   Congratulations Dileep and thank you for all that you do.     ### New collaboration between ERAS Society and Seoul National University Hospital A new milestone has been reached in the spread of ERAS in Asia. We are delighted to announce a collaboration between ERAS Society  and the Seoul National University Hospital (SNUH) . With the SNUH becoming the first ERAS Hospital in South Korea. This collaboration will enable patients to benefit from high-quality, evidence-based care at every stage of their surgical journey. ERAS® Society is proud and happy to welcome SNUH on board! We look forward to working closely with Prof Park, Prof Jeong, Dr Kim and Dr Lee. ### ERAS Roadshow held at Tan Tock Seng Hospital Singapore In conjunction with Global Surgery Day, Tan Tock Seng Hospital in Singapore held a 3 day ERAS roadshow from 25-27 May, with the theme “Safer Surgery, Stronger Recovery”, to increase awareness of the importance of perioperative care in postoperative recovery. Members of the public were treated to cutting edge surgical and anesthesia technology, information on smoking cessation, nutrition and exercise through interactive displays, games and quizzes. It rounded off with a public forum where the ERAS team in TTSH shared useful advice on  what the patient can do to help themselves prepare and recover from surgery. This was an important step in getting patients involved in their recovery journey!   Congratulations to Kwang Yeong How and the rest of the team. ### Professor Henrik Kehlet winner of the inaugural BJS Society Award We are immensely proud to announce that Henrik Kehlet, Professor of Perioperative Therapy at the University of Copenhagen, received the prestigious BJS Society Award for his ground-breaking involvement in Enhanced Recovery After Surgery. Professor Kehlet graduated in medicine at the University of Copenhagen in 1968 and finished his PhD nine years later for studies related to the surgical stress response in steroid treated patients. He became Professor of Surgery in Copenhagen in 1991 before becoming Professor of Perioperative Therapy in 2006, a post which he still holds today. For more than 20 years Henrik has been synonymous with ERAS related scientific research in many perioperative areas, and is still closely involved in the ERAS Society. Henrik is always inspiring people and young researchers as we saw at our 9th ERAS Society World congress in Lisbon last week where he actively contributed to the ERAS programme. On behalf of the ERAS Society I like to congratulate Henrik with this well deserved prestigious award. Hans de Boer Chairman ERAS Society    News release from the BJS Society 06 June 2023  EXCEPTIONAL SURGEON RECOGNISED FOR GROUNDBREAKING PROTOCOLS  IN WORLD-FIRST BJS SOCIETY AWARDS  A globally renowned surgeon has become the first ever recipient of the BJS Society Award which recognises an exceptional individual for their profound impact on patient care.  Henrik Kehlet, Professor of Perioperative Therapy at the University of Copenhagen, will receive the prestigious award for his ground-breaking “Enhanced Recovery After Surgery” (ERAS) protocols, which have changed clinical practice in multiple fields of surgery and improved outcomes for patients all over the world.  He was selected from more than 70 nominees, from across the world, following a rigorous judging process similar to the selection process for Nobel laureates, with a confidential panel of experts reviewing nominations made within the surgical community.  The accolade includes an award of €100,000, the largest monetary prize of its kind in the surgical field.  Professor Derek Alderson, Vice Chair of the BJS Society, said: “We are immensely proud to launch the biennial BJS Society Award this year, and it is a real privilege to announce Professor Henrik Kehlet as its first ever winner.  “In an era of sub-specialisation within surgery, few of the scientific discoveries of the 20th century apply to all branches of surgery and every group of surgical patients in the way Professor Kehlet’s have. His outstanding body of scientific work has application for virtually all surgical patients.”  Anders Bergenfelz, Chair of BJS Society, said: “The rubric for this award states that it should represent a discovery, innovation or scientific study within the field of surgery that has changed clinical practice with a profound impact on patient care. It is patently clear that Professor Kehlet’s outstanding work fulfills every one of these criteria.”  Professor Kehlet qualified in medicine at the University of Copenhagen in 1968 and was awarded his PhD in 1977 for studies related to the surgical stress response in steroid treated patients. He became Professor of Surgery in Copenhagen in 1991 before becoming Professor of Perioperative Therapy in 2006, a post which he holds to this day.  Henrik’s research interests have focused on a wide range of specialisms, including surgical pathophysiology, acute pain physiology and treatment, and postoperative fatigue, and over the years his efforts have condensed to form the concept of ERAS, a series of protocols which aim to achieve pain and risk-free operations.  The protocols borne out of by Professor Kehlet’s research involve a series of evidence-based care elements that can be applied before, during and after surgery, which all support recovery by reducing the bodily stress reactions caused by injury.  ERAS protocols not only produce better outcomes for patients and a more rapid return to better health, but also offers enormous financial benefits to the health care system. Kehlet’s concept is now generally accepted and implemented in all surgical societies, and with around 300 million surgical procedures performed worldwide each year, the impact has been significant.  Throughout his career, Professor Kehlet has published more than 1,250 scientific articles and has given more than 300 invited lectures at international scientific meetings.  Professor Kehlet said: “Receiving this award means a great deal to me. I’ve always thought it is important to look at why patients are in the hospital in the first place, then work backwards from there, step by step, to interrogate the multifactorial issues that can affect their outcomes and recovery. This is what my research has centered around over the last three decades and to this day remains the area I am most interested in and passionate about”.  BJS Society is a charitable foundation that owns the surgical journals BJS, BJS Open and BJS Academy, an online education resource and hub that supports the professional development of current and future surgeons.  Founded in 1913, BJS Society is responsible for ensuring any excess funds are used for charitable purposes to support the ongoing development and education of surgeons. This year, its charitable funds will support the BJS Society Award.  The award will be presented at a ceremony in Lausanne, Switzerland, on Friday 16 June.  ### ERAS Italy conference a success   In the lead up to our World Congress the Italian Chapter of the ERAS Society ran  a very successful conference in Florence on May 26th-27th.  The conference was was organised by Professor Luca Gianotti, the chairman of ERAS Italy, with locals hosts led by Prof Gabriele Baldini. The program included a series of current ERAS topics, and updated the current status of many disciplines both nationally and internationally. What was striking was the high level of presentation and engagement from the younger generations of all professions. Prehabilitation presented by Franco Carli, remote monitoring, surgical techniques and medical student engagement in ERAS as well as specialty sessions of high quality were some of the topics of the program. This conference is yet another proof of the ERAS movement gaining ground and anchoring with the coming generations of doctors, nurses, nutritionists, physiotherapists and others involved in the care of the surgical patients Professor Olle Ljungqvist ### ERAS-Japan welcomed as a new national Chapter On Sunday May 15 ERAS®Japan was officially inaugurated as a new ERAS®Chapter and partner to the ERAS®Society. The ceremony took place in Nagahama City with Professor Olle Ljungqvist co-founder and past chairman of the ERAS®Society and Professor Kyoichi Takaori from Nagahama city hospital, who has been leading the  development of the chapter. -Professor Takaori with our ERAS Society co-founder and past Chairman Professor Olle Ljungqvist   Professor Takaori is serving as the first President of ERAS®Japan, with a multi-professional and multidisciplinary board of prominent Japanese colleagues from around the country and from several Japanese medical societies. The inauguration ceremony took place at the Grazie Hotel during the first ERAS®Japan conference in front of 150 delegates. During the meeting invited national and foreign speakers and members of the Board of the newly formed ERAS®Japan presented on various ERAS related topics. Of special interest was the reporting of initial promising results from the first ongoing ERAS® Implementation Program at Nagahama city hospital led by Drs Kwang Yeong How and VerazLim from ERAS®Singapore.   -The team at Nagahama City hospital and the Coure Director Prof. Ljungqvist and Trainers Dr. Kwang Yeong and Dr. Vera.   The initiation of ERAS®Japan has caught a lot of attention in the medical world of Japan, and the Society is already connecting to and collaborating with all other ERAS®Society National Chapters in the region and is very welcomed and important ERAS®Chapter partner to the ERAS®Society.   A message from our Chairman: "The initiation of ERAS® Japan is an important development within the ERAS® Society globally. Therefore, I very warmly welcome our newest member in the global network of National ERAS Chapters. We congratulate Professor Takaori and his team for this great effort and look forward to collaborate with him and his team." Hans D. de Boer Chairman ERAS Society   -Welcome Address by the Mayor of Nagahama City, Mr. Nobuyoshi Asami ### Study weighs merits of post-op app for safer healing at home Further to our recent news article on the benefits of using a smart-app to help recovery. This is an article published on the Alberta Health Services website outlining an inspiring patient story about their recovery after major oncology surgery. Click here for more details.       ### Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges. Congratulations to our Gynecology Website Leads Prof Gregg Nelson and Dr Steven Bisch who helped write the update. ### Effect of Smartphone App Postoperative Home Monitoring After Oncologic Surgery on Quality of Recovery: A Randomized Clinical Trial There has been an increase in health care-focused smartphone apps, including those for encouraging healthy behaviours and managing chronic conditions, but app-assisted postsurgical care has yet to be fully explored. The authors attempted to compare the quality of recovery and patient satisfaction between conventional in-person follow-up and smartphone app-assisted follow-up for patients following ERAS protocols. In this RCT the authors randomised to either to smart phone follow up or conventional.  The smartphone app was able to record Quality of Recovery 15 (QoR15) scores, European Organisation for Research and Treatment of Cancer-selected adverse events, drain outputs, and surgical site photographs over 6 weeks, whilst being continually monitored remotely by a surgeon. The app group had significantly better QoR15 scores at both 2 and 6 weeks, and both equally satisfied. Complication rates were also similar. The surgeons involved also appreciated the early identification of complications using the app. Congratulations to Claire Temple-Oberle  (first author and the ERAS Breast speciality lead) and Gregg Nelson (senior author and treasurer of the ERAS Executive committee).  To read more click here. ### Framework for a new guideline for lower extremity vascular bypass Congratulations to Katherine McGinigle and the rest of the writing team for their work on this new consensus statement. This was a joint venture between the ERAS Society and Society for Vascular Surgery. A formal collaboration between the two societies who elected an international, multi-disciplinary panel of experts to review the literature and provide evidence based suggestions for coordinated perioperative care. ### Calling all AHPs involved in ERAS! Allied health professionals (AHPs) play a critical role in the successful implementation of Enhanced Recovery After Surgery (ERAS) pathways. AHPs such as physiotherapists, occupational therapists, dietitians, and speech therapists, play an integral role in ERAS pathways by providing key components of the program, including preoperative assessment and optimization, intraoperative care, and postoperative rehabilitation.   The ongoing involvement of AHPs in the future development of ERAS pathways is crucial for improvements to be made. By providing personalized aspects of care to patients, AHPs can help to reduce the risk of complications, improve patient outcomes, and decrease the length of hospital stay. The ERAS Society is committed to promoting the involvement of AHPs in ERAS pathways and encourages professionals who are interested in helping to promote ERAS across the world to get in touch. If you are an AHP interested in helping to promote ERAS pathways, we invite you to join us in our mission. Together, we can work to improve patient outcomes and enhance the quality of care for surgical patients across the world.    We are interested in hearing from AHPs such as Dietitians, Occupational therapists, Operating department practitioners, Physiotherapists, Radiographers, Speech and language therapists, as well Healthcare Scientists and Pharmacists. For more information on how to get involved, please contact us directly. ### Enhanced Recovery After Surgery (ERAS®) programme awarded the Patient Safety Excellence Award We are pleased to share that the “Enhanced Recovery After Surgery (ERAS)” programme at Tan Tock Seng Hospital in Singapore has been awarded the Patient Safety Excellence Award in the 2021 Asian Hospital Management Awards. Appointed by the ERAS® Society as a Centre of Excellence, Tan Tock Seng Hospital they have also organised annual symposia and hosted the 1st ERAS® Asia Congress in 2019. Congratulations to the team from Tan Tock Seng Hospital! ### In memory - Eivind Warberg This summer we lost one of our national ERAS® leaders. Eivind Warberg sadly died in a drowning accident in Norway. Eivind was the lead Doctor for ERAS at Östvold hospital, and was about to take on a teaching position for the Norwegian ERAS® Society. Dr Warberg was born in the Faro islands in 1976, got his medical degree at the University of Copenhagen, and via specialisation in surgery at Landssjukrahusiö Faro Islands, Rigshospitalet Copenhagen Denmark, Ullevål hospital in Oslo. He then completed his training at Östfold in Norway where he has since served. Eivind had a superb reputation as a brilliant surgeon and was a strong believer and enthusiastic leader of ERAS both at his hospital but he was also recognised internationally for his work. The ERAS® Society community and patients have lost a young a promising leader and driver for better care and all of us who had the fortune to get to know him have lost a great colleague full of enthusiasm, friendliness and ideas. Our thoughts go to his family in this time of sadness. ### NOW ONLINE: The ERAS and COVID-19 global seminar This free ERAS® Society webinar broadcasted on Saturday 27th of February in Europe and the Americas and March 6 in Australasia entitled “ERAS and COVID-19” covers how COVID-19 has developed a massive backlog of patients in need of surgery and how Enhanced Recovery After Surgery (ERAS) programs offers ways to manage this crisis in surgery today and tomorrow. The webinar is kindly sponsored by 3M. A number of world-class speakers are presenting with a Q&A panel at the end! Draft program and links to watching the seminar in different languages: English, Mandarin, Spanish, German and Japanese! ### NEW GUIDELINES on Emergency Laparotomy: Diagnosis, Rapid Assessment and Optimization The ERAS®Society Guideline on Emergency Laparotomy: Diagnosis, Rapid Assessment and Optimization is now available at World Journal of Surgery on line first (https://link.springer.com/article/10.1007/s00268-021-05994-9) More Guidelines from the ERAS®Society click here! ### Update - 2021 World Congress of the ERAS® Society and ERAS® USA We regret to inform you that the World Congress of the ERAS® Society and ERAS® USA due to be held in New Orleans in July 2021 has been cancelled due to the uncertainties involving travel and gatherings because of Covid-19. We hope to organise the next World Congress in Europe in April/May 2022. We will post updates about the 2022 Congress once the details, dates and venue have been confirmed. In the meantime, there will be an autumn conference hosted by ERAS® USA later this year, 10-12 November 2021. Full details of this event can be found on the ERAS® USA website and we will also post updates and details over the coming months. ### Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery Congratulations to the authors of the "Expert Consensus of Data Elements for Collection for Enhanced Recovery After Cardiac Surgery" which have just been published in the World Journal of Surgery.       ### ERAS Society lumbar spinal fusion guidelines now published The ERAS Society is delighted to report the recent publication of a "Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations" in the the Spine Journal. An international multi-disciplinary team of 12 authors was expertly led by French Neurosurgeon, Dr Bertrand Debono. ERAS is currently a hot topic in spinal surgery, and the ERAS Society extends its congratulations to all of the authors for collaborating on this important work.   ### Online ERAS Cardiac Conference, 5th-6th March 2021, Houston, TX We are pleased to invite you to the ERAS® Cardiac Society Virtual Conference LIVE from the Methodist Hospital DeBakey Center in Houston, TX, designed to optimize outcomes through global collaboration. Join us March 5-6, 2021 for a one-of-a-kind experience featuring live debates and discussions from an engaging panel of multidisciplinary experts discussing the latest in cardiac enhanced recovery and treatment innovations. Registration: erasvirtual2021.com   ### ERAS Society sessions in Shanghai viewed over 50,000 times The ERAS Society cooperated in arranging the OCAP2020 (Oriental Congress of Anesthesiology and Perioperative Medicine) congress in Shanghai in October. This congress was huge success with more than 4,000 delegates in place at the venue in Shanghai and with more than 50,000 delegates attending the ERAS Society day long session on line. In this session speakers from the ERAS Society alongside experts from inside and outside China delivered up to date presentations about ERAS. We are grateful to Professor Miao the main host of the congress and his excellent team for a very nice and fruitful collaboration and we look forward to working with our Chinese colleagues to further spread ERAS in China and Asia. In due course, members of the ERAS Society will be able to watch the presentations via the website. You can join the society via our membership page  ### ERAS® Society 10th anniversary World day - 14th Nov 2020     Join colleagues from around the world for the ERAS® Society 10th anniversary World day. This global webinar will take place on the 14th November, 2020 Clinical experts in the ERAS® Society from around the world will deliver a series of short lectures and discuss key ERAS® papers. Join the free webinar from wherever you are! ERAS Society Webinar Programme and Speaker Biographies 14 Nov 2020 Register for the time zone that suits you by clicking on the links below: Asia and Australia  Time Zone 1 https://us02web.zoom.us/webinar/register/WN_yrNyHf6tTjKX4kSqjftBaA Africa and Europe Time Zone 2  https://us02web.zoom.us/webinar/register/WN_nk0Kwrz8Q2mcu87IUlcZ9Q Latin America and USA  Time Zone 3 https://us02web.zoom.us/webinar/register/WN_iDqRqE2IQNqPTTU5gDtbrQ If you are an ERAS® Society member, the webinars will also be available to view afterwards. To join the ERAS® Society click here   Following the three webinars, the ERAS Society USA Chapter, invites you to join them for their virtual conference "ERAS Updates and Future Directions". Please find below the link to ERAS® USA Program and how to register https://erasusa.org/meetings/virtual/2020/program/   ### European Society of Anaesthesiology and Intensive Care (ESAIC) The ERAS® Society is a Specialist Society member of the newly renamed European Society of Anaesthesiology and Intensive Care (ESAIC). Previously the European Society of Anaesthesiology, ESAIC has more the 9,700 full members and more than 20,000 associate members. It remains the second largest Anaesthesia Society globally and holds the most prominent position in the community of anaesthesiologist in Europe and elsewhere. To visit the ESAIC website click here.   The Euroanaesthesia Virtual Congress is coming soon (28-30 November 2020) and is Europe’s largest annual event showcasing the latest news and innovations with medical experts active in the field of anaesthesia, perioperative medicine, intensive care, emergency medicine, and pain treatment. For more information please click here.     ### Pre-operative Patient Education - Bite Size Education Series Video https://youtu.be/pyRKCcN8XkI This is a short interview with nurses Jennie Burch and Angie Balfour. It aims to highlight the importance of preoperative patient education, a cornerstone principle of ERAS, which aims to prepare patients for their operation and their recovery. Both Angie and Jennie have been working as ERAS nurses for over a decade in Edinburgh, Scotland and St Mark’s Hospital, London. They have seen ERAS evolve over time and have watched it's implementation spread from one specialty to another reaching to all patients who have elective surgical procedures. Jennie and Angie have also written a chapter featured in the ERAS textbook (available here) ### Registration now open for ERAS® Society 10th anniversary webinars on 14th Nov 2020 Registration is now open for the previously announced, ERAS® Society 10th anniversary World day. This global webinar will take place on the 14th November, 2020 Clinical experts in the ERAS® Society from around the world will deliver a series of short lectures and discuss key ERAS® papers. Join the free webinar from wherever you are! Click here for the programme   Register for the time zone that suits you by clicking on the links below: Asia and Australia  Time Zone 1 https://us02web.zoom.us/webinar/register/WN_yrNyHf6tTjKX4kSqjftBaA Africa and Europe Time Zone 2  https://us02web.zoom.us/webinar/register/WN_nk0Kwrz8Q2mcu87IUlcZ9Q Latin America and USA  Time Zone 3 https://us02web.zoom.us/webinar/register/WN_iDqRqE2IQNqPTTU5gDtbrQ   If you are an ERAS® Society member, the webinars will also be available to view afterwards. To join the ERAS® Society click here ### ERAS SOCIETY® 10th ANNIVERSARY – WORLD DAY https://youtu.be/tHswHaAa8lY   We are delighted to announce a global ERAS SOCIETY® webinar on 14th November 2020 spaced several hours apart  for three different time zones. There will be a number of lectures and key papers with input from major contributors to Worldwide ERAS, including our Chairman, Professor Olle Ljungqvist and other members of the Executive Committee. Choose a  time that suits you!  We look forward to welcoming you to this free webinar, which will be available free to ERAS SOCIETY® members to view after the event.  ### Congratulations to ERAS LatAM - Celebrating 3 years of spreading ERAS in South America and the Caribbean ERAS LatAm is the Latin American chapter of the ERAS® Society. Its mission is to facilitate the full implementation of an ERAS program in the countries of South America and the Caribbean. It also seeks to promote the training of its members and formalise a network for the creation of knowledge.   [Go to ERAS LatAM] ### Stopping opioid-related addiction, harm and accidents after surgery – international experts come together to publish guidance The opioid crisis, in which addiction and harm are related to pain-relieving opioid drugs, has been well documented. It has been concentrated in the USA but is now affecting most Western nations and increasingly, developing countries also. In some cases, this addiction and subsequent harm begins when the patient is given these drugs for pain relief after surgery. To help confront this, an international group of global experts including anaesthetists, surgeons and other healthcare professionals have come together to publish a consensus statement on the prevention of opioid-related harm in adult surgical patients. The consensus statement is published in Anaesthesia (a journal of the Association of Anaesthetists). “Opioids are effective medicines that form an integral component of balanced multimodal painkilling strategies for the management of acute pain in postoperative patients,” explain the statement co-authors, who include Professor Dileep Lobo, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK. “However, over the past decade it has been increasingly appreciated that, in efforts to improve pain relief after surgery, doctors prescribing these drugs to help pain relief during and after surgery have unwittingly contributed to persistent postoperative opioid use, abuse and harm in some patients.” They add: “In addition to the social and economic costs of opioid misuse, there are personal costs, with many people dying from opioid overdose, or in accidents caused, for example, by driving under the influence of opioids.” Ways to reduce possible harm begin before surgery, since the strongest predictor of persistent postoperative opioid use post-surgery is pre-existing chronic opioid use. The incidence of persistent postoperative opioid use can be up to 10 times higher in those taking opioids long- term before surgery than in patients who have never used opioids. The main points from the consensus statement are: All patients undergoing surgery should be assumed to be at risk of developing persistent postoperative opioid use/addiction and may need interventions to mitigate those risks. However, some patients are at particularly high-risk of opioid related respiratory impairment, including older patients; those with sleep-disordered breathing; obesity; kidney disease; respiratory, cardiac and neurological diseases; diabetes; tolerance to opioids; and genetic variations in opioid metabolism. Healthcare teams must consider optimising management of pre-operative pain and psychological risk-factors before surgery, including weaning patients off opioids they are already taking where possible. They should ensure realistic expectations of postoperative pain control, both in hospital and after discharge. Provision of opioid painkillers should be guided by functional outcomes, rather than just a rating of the patient’s pain using existing scales. Multiple methods of pain management should be optimised, and patients educated about the use of non-pharmacological and non-opioid painkilling strategies to reduce the amount and duration of opioids required to restore function Long-acting opioids should not be used routinely for acute postoperative pain. (e.g. modified-release oxycodone, transdermal fentanyl patches) A patient-centred approach should be used to limit the number of tablets and the duration of usual discharge opioid prescriptions, typically to less than a week. (Post-discharge prescriptions of opioids, if necessary, should be limited to less than a week’s duration. A small number of patients may need repeat prescriptions, but these should not be automatic. GPs should see patients and assess them before re-prescribing opioids). Automated post-discharge repeat prescriptions for opioids should be avoided. Doctors, including those in outpatient clinics and general practice, should perform a patient review if more opioids are requested. Research has shown each additional repeat prescription has been found to increase the risk of opioid misuse (encompassing diagnoses of opioid dependence; abuse; or overdose) by 40%, with each additional week of opioids taken raising the risk of misuse by 20%. (A small number of patients may need repeat prescriptions, but these should not be automatic. GPs should see patients and assess them before re-prescribing opioids). Patients should be advised on safe storage and disposal of unused opioids and directed to avoid opioid diversion to other individuals (e.g. sharing with friends and family). Addiction surveys have shown that around 50% of adults who misuse opioids obtain them from friends and family. This also avoids accidental deaths. Paediatric mortality from unintentional opioid overdose has increased three-fold in the last 20 years and has followed a similar time trend to adult overdose deaths The authors also highlight the dangers of driving under the influence of opioids, that can impair driving skills and cognitive reasoning in a similar manner to alcohol. “Driving under the influence of drugs, including prescribed opioids, is now recognised to be a major cause of motor vehicle collisions and subsequent fatalities, particularly if the person commenced the opioid within the previous 30 days,” explain the authors, who add that many countries have established laws making driving under the influence of opioids illegal. They conclude: “While the use of opioids during and after surgery has the capacity to promote recovery after life-saving or life-enhancing surgery, their use can be associated with harm from persistent postoperative opioid use; opioid-induced respiratory impairment; opioid diversion to people they were not originally prescribed for; and driving under the influence of prescription opioids. Strict control of opioid use within hospitals (stewardship) is required to minimise the risk of opioid-related harm. This will require the multidisciplinary involvement of anaesthetists; surgeons; pain specialists; pharmacists; nursing staff; physiotherapists; primary care clinicians; hospital management; and patients to adopt the recommendations from this consensus statement to local practice.” Click here for the article Professor Dileep Lobo, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, UK. +44-7545966471) dileep.lobo@nottingham.ac.uk Co-author Dr Kariem El-Boghdadly, Consultant Anaesthetist, Guy’s and St Thomas' NHS Foundation Trust, London, UK. Please e-mail first to arrange interview. T) +44 7958 904883 E) editor-kariem@anaesthetists.org Co-author and expert on pain medicine and addiction: Dr Jane Quinlan, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. T) +44 7545 995 615 E) jane.quinlan@ouh.nhs.uk ### ERAS HIPEC guidelines now published in European Journal of Surgical Oncology The ERAS Society is delighted to announce that the "Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS®) Society Recommendations" have now been published in 2 parts in the European Journal of Surgical Oncology. The articles are both open access Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced recovery after surgery (ERAS®) Society Recommendations d Part I: Preoperative and intraoperative management Guidelines for Perioperative Care in Cytoreductive Surgery (CRS) with or without hyperthermic IntraPEritoneal chemotherapy (HIPEC): Enhanced Recovery After Surgery (ERAS®) Society Recommendations — Part II: Postoperative management and special considerations ### Compliance in ERAS - An interview with Prof Olle Ljungqvist In this video ERAS Society Chairman, Prof Olle Ljungqvist talks about how important it is to comply to ERAS care elements if you want to improve patient outcomes through ERAS programmes. https://youtu.be/z7IiLMucPdE   ### New Editorial in the BJA from Prof Dileep Lobo and colleagues In a new editorial in the British Journal of Anaesthesia, Prof Dileep Lobo and colleagues argue that it is time to sit back and rethink about how we view ‘waiting lists’ for elective surgery. The article is titled "Turning ‘waiting lists’ for elective surgery into ‘preparation lists’". For the full article click here    ### COVID-19 update to the ERAS® Interactive Audit System The ERAS® Interactive Audit System, can now also be used to track your patient’s Covid-19 status. This will be beneficial for surgical teams to keep track of the patient’s Covid-19 status and identify how the patient’s Covid-19 status affects the outcome of care. The selection items are based on the WHO Clinical Coding for Covid-19. Since some studies show long term effects in COVID patients, this data can be used to study how these cases respond to recovery after surgery in the long run. The ERAS® Interactive Audit System comes with a set of protocols based on the ERAS® Society published guidelines and is used to register, measure, and audit your patient’s perioperative care process. If you are using an audit system for ERAS® practice, there are some parameters that may be of high value to you for planning backlog surgeries and identifying the best perioperative measures. Please read more here. Please contact Encare directly if you have questions regarding the ERAS® Interactive Audit System and how to implement ERAS®. ### First Chinese ERAS Society affiliated hospital On the 18th August 2020, a Memorandum of Understanding between the ERAS Society and the First University Hospital of Lanzhou China was signed. Prof Li, president of the First University Hospital of Lanzhou signed, along with Prof Olle Ljungqvist and Prof Nicolas Demartines from the ERAS Society. The agreement proceeds the formal implementation of an HPB ERAS program in Lanzhou. This will be the first Chinese ERAS affiliated hospital! ### NEW! Guidelines for Vulvar and Vaginal Surgery: ERAS Society Recommendations The first collaborative Enhanced Recovery After Surgery (ERAS) Society guideline for optimal perioperative care for vulvar and vaginal surgery has recently been published in the American Journal of Obstetrics and Gynecology. Congratulations to all of the authors for their roles in producing this valuable work. Click here to access the guidelines. ### New editorial on enhanced recovery after Caesarian Congratulations to Dr Laurent Bollag and Prof Gregg Nelson on their recent editorial titled "Enhanced Recovery After Cesarean (ERAC) – beyond the pain scores" published earlier this month in the International Journal of Obstetric Anesthesia. Click here for the article. ### The Post COVID-19 Surgical Backlog: Now is the Time to Implement ERAS Members of the ERAS Society Executive Committee; Prof Olle Ljungqvist, Prof Gregg Nelson, and Prof Nicolas Demartines have just published an editorial in the World Journal of Surgery describing the post COVID-19 surgical backlog and the role ERAS can play in helping to deal with it. Click here to access the article. ### Enhanced recovery after surgery in paediatrics: a review of the literature Congratulations to Prof Mary Brindle and colleagues on their new publication. The article compares the differences between enhanced recovery after surgery (ERAS), perioperative surgical home and fast-track surgery. It explains the various components of an ERAS protocol in paediatrics, and proposes future directions for multidisciplinary paediatric standardised care protocols. Click here to access the article. ### "Enhanced Recovery After Surgery: A Review" named in JAMA Surgery top 5 articles As JAMA Surgery celebrates 100 years in publication, it has recently announced some important milestones Impact Factor of 13.6, the highest ranking surgery journal in the world Reaching nearly 100,000 readers each week via email alerts and social media More than 8.3 million annual article views and downloads More than 7,500 media mentions in 2019 and 2020, including 38 of the top 50 Altmetric scores for general surgery articles It has also named the article "Enhanced Recovery After Surgery: A Review" written by Prof Olle Ljungqvist, Prof Michael Scott, and Prof Kenneth Fearon as one of the top 5 articles in the journal. Click here to read the article, which has been viewed over 42,000 times and cited 550 times.   ### Call for papers focussing on Nursing and Allied Health Professional research in ERAS There is an open call for papers focussing on Nursing and Allied Health Professional research in ERAS. The journal Medicina has an open Special Issue titled "Nursing and Allied Health Professional Focused Research on Enhanced Recovery after Surgery (ERAS)". It is calling for articles that highlight the innovative work undertaken by nurses and allied health professionals within ERAS pathways across all surgical specialties. Research led by or involving nurses, operating department practitioners, physiotherapists, occupational therapists, dieticians, pharmacists, radiographers, healthcare assistants, or any other non-medical professionals involved in ERAS is being welcomed. This includes research from work conducted at the pre-operative, intra-operative, post-operative, and post-discharge stage. For more details click here ### The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery Brief summary: After including the results of two recent randomised controlled trials, this updated meta-analysis suggests that oral antibiotics alone or a combination of mechanical bowel preparation and oral antibiotics is superior to no bowel preparation in patients undergoing colorectal surgery when surgical site infection and anastomotic leak rates are considered. The article is available here. Prof Dileep Lobo ### Prof Ljungqvist presents ERAS at the Nordic Innovation Summit 2020 Professor Olle Ljungqvist joined colleagues at the National Nordic Museum's "Nordic Innovation Summit 2020 presented by Ericsson",  a virtual event held on May 14, 2020, to talk about ERAS. There is a link below to watch the session https://youtu.be/kdd5BcC2iyM?t=184   ### UPDATE - The 2020 Joint Congress of ERAS Society and ERAS USA has been postponed until 2021 The organizers of the 2020 Joint Congress of ERAS Society and ERAS USA have been closely monitoring updates and recommendations from the Centers for Disease Control and Prevention (CDC) and from the World Health Organization (WHO).  We have also been actively following travel advisories and restrictions placed on hospitals and institutions, and stay-at-home orders in countries around the world.  While we all had hoped to come together in New Orleans, Louisiana, USA this August for our Joint Congress, we firmly believe that putting the health, safety and wellbeing of our attendees, and their patients and families, comes first.  It is with heavy hearts that ERAS Joint Congress has made the difficult but necessary decision to postpone our 2020 Congress, and move it forward to July of 2021. Full details including information on abstract submissions, registration, and refunds will be sent out shortly.  We appreciate your patience and understanding as we work through the best way to make this convenient for our members, attendees and industry partners. ### Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery now Published! Congratulations to Dr. Brindle and colleagues on the recent publication of the "Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations". The paper has been published open access in the World Journal of Surgery, and is available here. ### ERAS® Society USA Chapter and Office of National Drug Control Policy Webinar - Recording Now Available Webinar on Enhanced Recovery After Surgery (ERAS): Medical education engagement to support safe prescribing for patients needing surgery This webinar, which included prominent ERAS leaders including ERAS® USA President-Elect Dr. Michael Scott and ERAS® USA Past President Dr. Tonia Young-Fadok, was designed for health care leaders to learn about the National Drug Control Strategy and how the surgical community has an important role in optimal surgical outcomes as well as safe prescribing education, prevention, and referral to addiction services. The Office of National Drug Control Policy (ONDCP) with the assistance of ERAS USA have organized this webinar. The Public Health, Education and Treatment team hopes to utilize this webinar as an opportunity to communicate the Administration’s support for safe prescribing practices and the role of the entire health care community in leading the path in both prevention as well as treatment for those who need surgical care. https://youtu.be/UEUM9u8XdIU ### ERAS® Society Executive Committee Statement regarding surgery and anaesthesia during the COVID-19 pandemic The COVID-19 pandemic is sweeping across the world and affecting all of us gravely. It impacts upon surgical practice substantially by necessitating cancellation or postponement of the majority of elective operations to create capacity for the management of patients in need of treatment for COVID-19. Several countries, surgical societies, national associations and journals have published guidelines on how to manage these patients, many of which can be found with a simple internet search using “COVID-19 Guidelines for surgery”. There are also case series soon to be published showing how units have managed their patients during this crisis. The ERAS® Society chooses not to publish guidelines on this topic but rather point to the fact that for the patients who do undergo elective surgery, it is now more important than ever before to implement ERAS® pathways, given the increased importance to avoid complications, intensive care admission and to have patients in a condition to leave the hospital as soon as possible. It must also be highlighted that at present there is little or no scientific evidence to base recommendations for the treatment of COVID-19 patients undergoing surgery, but at this point in the development of knowledge it is relying on opinion and use of information from other pathogens in different situations that will shape any future guidelines. Professor Olle Ljungqvist Professor Gregg Nelson Dr Hans De Boer Professor Nicolas Demartines Professor Dileep Lobo Professor Michael Scott Professor William Fawcett Ms Angie Balfour ### Over 103,000 views of the ERAS Society and ERAS Cardiac Society Guidelines Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations JAMA Surgery has reported that the ERAS Society and ERAS Cardiac Society Guidelines were the highest viewed paper in 2019 in the journal. JAMA Surgery is the first surgical journal to reach double digits in impact factor with 10.7 and is now the worlds highest ranking surgical journal! The views exceeded 103,000 with the second scoring paper at around 31,000. We congratulate Dan Engelamn and the entire team behind this milestone achievement reflecting the impact and importance of ERAS as it is moving across different specialties. Read the full editorial here ### Textbook now available to order! ERAS - A Complete Guide to Optimizing Outcomes The text book "Enhanced Recovery After Surgery A Complete Guide to Optimizing Outcomes" edited by Prof Olle Ljungqvist, Prof Nader Francis, and Prof Richard Urman is now available to order on the Springer website. The book Provides a broad and comprehensive overview of ERAS with expert opinions from leaders in the field regarding elements of care that are both generic and specific to various surgeries First comprehensive, authoritative book on the subject that covers the patient journey through such a program, commencing with optimization of the patient’s condition, patient education, and conditioning of their expectations Discusses metabolic response to surgery, anaesthetic contributions, and optimal fluid management after surgery, providing examples of ERAS pathways and practical tips on post-operative pain control, feeding, mobilization, and criteria for discharge Helps an existing user of ERAS care and centers with established programs by outlining causes of deviation and failure and suggesting modifications that may be necessary ### Save the date - International Surgical Week (ISW) 2021 - Aug 29-Sep 2, 2021, Kuala Lumpur, Malaysia ​           Engaging and insightful, the International Surgical Week (ISW) 2021 will be unlike any other meeting. Offering scientific excellence in the field of surgery at an affordable price, the event will bring together many of the world's leading experts. ISW 2021 will also provide a platform for scientific and clinical working groups where they can collaborate to establish the foundations for future diagnostic and surgical challenges, and discuss novel approaches and standards, facilitating progress towards real-time, patient-oriented solutions. For more information visit www.isw2021.org or visit The International Society of Surgery website www.iss-sic.com     ### Updated ERAS Society guidelines for Pancreatoduodenectomy now published! The new "Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019" have just been published in the World Journal of Surgery. This is an update following the  first published guidelines in 2012, and is based on the best available evidence and on expert consensus. ### Guidelines for Perioperative Care in Cardiac Surgery - Now over 107,000 views/downloads Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations We are delighted to report that the “Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations" published in JAMA Surgery in August, 2019, have now received over 107,000 views/downloads since its release. Further to this, the manuscript has achieved an Altimetric attention score of 322, which makes it one of the top research outputs scored by this group. JAMA Surgery is the highest impact factor peer reviewed surgical journal, with an impact factor of 10.668, and this article was the most viewed manuscript in 2019. We are pleased that our contribution has garnered so much attention from our peers in cardiac surgery, cardiac anesthesia, critical care, and nursing. We look forward to continuing to standardize best practice surrounding the perioperative care of cardiac surgical patients through expert consensus, review of the literature, and open communication. Congratulations to the ERAS® CARDIAC Board of Directors and Authors ### Letter from the ERAS Society Chairman - Reviewing 2019 and Previewing 2020 Chairman: Professor Olle Ljungqvist 2019 – Thank you all for another great ERAS® Society year It is with great happiness and pride that I can summarize that 2019 has been yet another year of great developments for ERAS® and the ERAS® Society. This year the ERAS® Society Guidelines surpassed 4,000 citations in PubMed, and when these guidelines are put in use, several reports from different surgeries also show that both short- and long-term outcomes improve. The interest in ERAS® is mirrored by the number of ERAS® publications that are constantly growing; up from around 40 15 years ago to over 600 in the last year. ERAS® makes a big difference in outcomes and this is why ERAS® is a top subject in surgery and anesthesia. The ERAS® Society is very active in a range of different areas, and I am proud to mention just a few highlights that have been accomplished by a large number of great leaders, experts and collaborators around the globe: Guidelines: This year ERAS® Society Guidelines broke records in downloads in JAMA Surgery (highest impact journal in surgery) with the Guideline on Cardiac Surgery, and the update of the Colorectal Guideline was a big hit. We were also happy to have just released the Guideline on Hip and Knee replacement surgery on-line. This year the Society also published a guideline for ERAS® Society Guidelines outlining the history behind them and how they have developed into the methodology used currently. Joining forces: During 2019 we established and strengthened bonds with major Anesthesia Societies – the Brazilian and the European Societies of Anaesthesiology. With these two prominent Societies we will be able to bring the true ERAS® to many more hospitals globally. Implementation worldwide: Several countries in LATAM are joining the ERAS® Society and ERAS® LATAM, and in countries already with Centers of Excellence present, we are seeing them now training other hospitals in their countries. In Brazil a total of seven new hospitals are engaged in an ERAS® Implementation Program with the ambition to spread it across the country in a collaborative manner with the Brazilian Society of Anesthesiology. In the US, Mayo Clinic and Brigham and Women’s Hospital are now trained as Centers of Excellence and starting to help other units implement ERAS® across the USA. In Asia the first hospital in India is in training, as is the first in Dubai, with more countries joining early next year; Taiwan and Thailand are next in line to follow Singapore, Philippines and Vietnam. In Europe new units across the continent are being trained and in South Africa plans are laid out for spreading ERAS® inside and outside the country. Congresses and meetings: This year’s main event was the 7th ERAS® World Congress successfully run with ERASUK in Liverpool, UK. An excellent program was held over 3 days with almost 600 delegates from over 70 countries. The 1st ERAS®ASIA congress was held in Singapore to meet the growing interest and demand for ERAS® in this part of the world. More than 200 delegates covering most countries in Asia made this returning event a huge success. In addition, numerous ERAS® sessions and presentations have been part of just about every major international and national congress around the world; many of these presentations are delivered and sessions organized by ERAS® Society members and collaborators. Lastly, in several countries national ERAS® Society Chapters have held congresses and events. What is in line for 2020? Next year’s main event will be the 8th ERAS World Congress, in collaboration with ERAS®USA in New Orleans, USA August 26-28. Several local or regional events will take place across the globe – keep an eye on the ERAS® Society website for updates. The ERAS® Society Textbook will be released by Springer, USA during the first quarter of 2020. The title is: Enhanced Recovery After Surgery – A Complete Guide to Optimizing Outcomes. The textbook has 65 chapters written by world leaders in ERAS®, covering all you need to know about ERAS®. The ERAS® Society will launch a formal membership early next year. Membership will provide a series of benefits in addition to being part of an international multi-professional and multi-disciplinary medical society that is changing the course of surgery and anesthesia: - On line subscriptions to 4 leading journals: World Journal of Surgery, European Journal of Anaesthesiology, Current Opinion in Anesthesiology, and Current Opinion in Critical Care - ERAS® Society textbook: Discounted price on the textbook (released during the 2st quarter of 2019) from Springer – all you need to know about ERAS® – 65 chapters, written by world leading authors. - Congress fee rebate: Reduced registration at the 8th World Congress in New Orleans. Details to be announced on the website shortly. Guidelines: new and updated guidelines are under way for 2021 Let me thank all of the excellent collaborators and co-workers involved in the ERAS® Society who have made these tremendous successes possible and who have dedicated their precious time and knowledge to help move ERAS® forward with the goal to improve outcomes for patients. I wish all of you the very best for the holidays and the New Year. It has been an honor and privilege to serve as the Chairman of this formidable group of people working for the ERAS®Society. Sincerely, Olle Ljungqvist Chairman ERAS® Society Executive Committee ### A WORLDWIDE SURVEY LOOKING AT PANCREATODUODENECTOMY PAIN MANAGEMENT, FLUID THERAPY, AND THROMBOPROPHYLAXIS FOLLOWING PANCREATODUODENECTOMY: A WORLDWIDE SURVEY The benefits of enhanced recovery protocols are clearly established. However, little is known about different practices of enhanced recovery protocols following pancreatic surgery around the globe. The aim of this survey study is to assess perioperative practices among surgeons and anaesthetists regarding pain management, fluid therapy, and thromboprophylaxis in patients undergoing pancreatoduodenectomy. We invite you to fill out a short survey (~5 min) as part of our study. Please fill out the complete survey once: https://eraspancreas.limequery.com/921335?lang=en   Many thanks on behalf of the study group, J.V. Groen, R.G. Hanna Sawires, E. AlEassa, M. Adham, C.H.C. Dejong, C.H. Martini, J. Vuyk, A. Dahan, B.A. Bonsing, A.L. Vahrmeijer, M.G. Besselink, N. Pecorelli, T. Hackert, T. Ishizawa, T. Miller, J. Samra, A. Sauvanet, G. Morris-Stiff, J.S.D. Mieog ### ERAS Society Hip and Knee recommendations now published online by Acta Orthopaedica and free to download   The ERAS Society are delighted to announce that a “Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations” has now been published online by Acta Orthopaedica and is open access. Congratulations to Tom Wainwright and colleagues on their fine work and valuable contribution. The guidelines are available for FREE download here                ### 5th Annual Mayo Clinic Enhanced Recovery After Surgery (ERAS) 2020.   Join Course Director, Tonia M. Young-Fadok, and colleagues for the 5th Annual Mayo Clinic Enhanced Recovery After Surgery (ERAS) 2020. To be held in Phoenix, Arizona, on the 28-29 February 2020. Click here for full course details and registration. ### Save the date! 8th ERAS Society World Congress, New Orleans, 26-28 August 2020 Save the date! The ERAS Society and the ERAS Society USA Chapter would like to invite you to attend the 8th ERAS Society World Congress to be held jointly with the 4th ERAS USA Congress, in New Orleans, 26-28 August 2020. The conference details and programme will be announced over the coming months but we are delighted to announce the invited speakers for the prestigious Henrik Kehlet and Ken Fearon lectures. The Ken Fearon Lecture - Professor Sanjeev Arora, MD, MACP, FACG, Professor of Medicine, Department of Internal Medicine, University of New Mexico School of Medicine. The Henrik Kehlet Lecture - Professor Carol Peden, BSc(Med Sci), MB ChB, MD, FRCA, FFICM, FFMLM, MPH, Professor of Anesthesiology, University of Southern California in Los Angeles ### 1st ERAS Asia Congress 2019, Singapore The inaugural ERAS Asia Congress took place over 26-28th September 2019 in Singapore. Kicking off with a pre-congress workshop and a site visit to Tan Tock Seng Hospital, an ERAS Centre Of Excellence since 2016, the congress opened to more than 250 participants from across 17 countries worldwide. Over 2 days of insightful talks by international and regional experts, the participants and faculty engaged in interactive discussions and sharing of ERAS experiences. Highlights of the Congress included updates on ERAS protocol and global developments, patient experience sharing, and an Asia Pacific experts panel discussion. The Congress ended on a high with regional ERAS leads making a commitment to collaborate and advance ERAS practices within their own countries and the region, with efforts culminating at ERAS Asia Congress in Manila In 2021! ### Video - ERAS in Head And Neck Cancer: An International Update Merran Findlay, Executive Research Lead - Cancer Nutrition and Oncology Specialist Dietitian (Sydney, Australia) sat down with three international experts to gain their insights and experiences in implementing Enhanced Recovery After Surgery (ERAS) in head and neck cancer. Featuring Professor Olle Ljungqvist (Örebro University, Sweden), Professor Joseph Dort (University of Calgary, Canada) and Professor Leah Gramlich (University of Alberta, Canada). https://youtu.be/mwfQ7EsvykE   ### 1st Meeting of ERAS in Thoracic Surgery in Chile - 5 Sep 2019 The first meeting in Chile to discuss ERAS in Thoracic Surgery will be held on the 5th September 2019 with an international faculty including Dr. Tim Batchelor, a Thoracic Surgeon. from the University Hospitals Bristol NHS in the UK and also lead author of the recently published ERAS guidelines. Information and registration  Chile - 1st Meeting of ERAS in Thoracic Surgery - Programme Chile - 1st Meeting of ERAS in Thoracic Surgery - Flyer     ### Skaraborgs Sjukhus Skövde, Sweden, awarded The Golden Scalpel for their work in ERAS Lars Johansen, Consultant Surgeon, Eleonora Ingmarsson, Assistant Nurse and Thomas Karlberg, Anaesthetic Nurse. Congratulations to the ERAS team from Skaraborgs Sjukhus Skövde who were awarded the prestigious Swedish medical price, the Guldskalpellen (The Golden Scalpel), for their introduction and maintenance of their ERAS program. A great achievement in a hard competition with over 30 other nominees. The annual prize is given for the best innovation that has improved the quality of care for patients. ### The ERAS® Society becomes a Specialist Society member of the European Society of Anaesthesiology  At the recent scientific annual meeting of the European Society of Anaesthesiology (ESA) in Vienna, Austria, the Board of Directors of the ESA decided that the ERAS® Society will become a Specialist Society member of the European Society of Anaesthesiology. With more the 9,700 full members and more than 20,000 associate members, the European Society of Anaesthesiologist is the second largest Anaesthesia Society globally and holds the most prominent position in the community of anaesthesiologist in Europe and elsewhere. The mission of the European Society of Anaesthesiologist is to promote the professional role of anaesthesiologists, to improve perioperative patient outcomes by focusing on the quality of care, patient safety strategy and scientific research. The objective of this international collaboration is to define joint strategies to promote perioperative care worldwide with the best scientific evidence-based medicine practices according to the ERAS® Society methodology. Furthermore, we have agreed to extend collaboration between the Societies in the field of education and scientific research according to the operational guidelines of the ERAS® Society. The ERAS® Society is asked to submit one or two session proposals for presentation at the scientific annual meeting of the European Society of Anaesthesiology annual ESA congress. The members of the ERAS® Society will be offered many benefits as part of their membership of the European Society of Anaesthesiology. The Societies will cross announce events of joint interest thereby reaching many more professionals. We are looking forward to this new international collaboration. Hans de Boer and Olle Ljungqvist ### Speakers announced for ERAS Asia Congress, 27-28 Sept 2019, Singapore Join ERAS Asia and the ERAS Society for the 1st joint Congress in Singapore, 27-28 September 2019.   ### Report on the 7th ERAS® World Congress The 7th ERAS® Society World Congress was held at The Arena and Convention Centre Liverpool, UK, from 1 - 3 May 2019. It was held jointly with its UK Chapter, ERAS UK, as their 9th ERAS® UK Conference. Enjoying the iconic city of Liverpool, the Congress was very successful in attracting 523 registrations  worldwide, with the majority (over 60%) from Europe, but with significant numbers from Asia (20%) and North America (12%) as shown in the table below. CONTINENT NUMBERS Europe 325 Asia 103 North America 61 Africa 14 Oceania 7 South America 9   There were large numbers of local (UK) delegates and in addition it was encouraging to see that both China and United States supporting the congress in large numbers as well several other European Countries as shown in the table below. COUNTRY NUMBERS United Kingdom 162 China 52 United States 49 Sweden 30 Netherlands 21 Denmark 17 Switzerland 15 Saudi Arabia 13 Canada 11 Germany 11   Whilst not quite surpassing last year’s record numbers in Stockholm (585) the figures are still much higher than other previous Congresses in Lyon in 2017 (393), Lisbon in 2016 (389) and  Washington  in 2015 (492) - which was a combined meeting with EBPOM and ASER. These figures reflect a sustained interest for ERAS worldwide. We also had 104 posters presentations (102 last year) with 6 best abstracts selected for oral presentation and 7 rapid fire abstracts accepted. All are published in Clinical Nutrition ESPEN 2019;31:1-146 with a link to the abstracts published here. The Pre-congress programme (Wednesday 1st May) has now become a packed day with four parallel streams running.  The ever-popular ERAS® half day course where delegates learnt about the relevant pathophysiology and perspectives from different healthcare professionals – surgeon, anaesthetist  and nursing experts. However in addition there were other speciality-specific sessions with a full day 2nd ERAS® Society World Congress in paediatrics and low income countries, as well as sessions on cardiac, orthopaedics, urology, gynaecology and nursing & AHP. The Scientific Programme began on Thursday 2nd May and following addresses by both the ERAS® Chairman Professor Olle Ljungqvist progress on the new ERAS® Society Textbook was presented. Professor Nader Francis (Congress President), delivered the Presidential Address “The Global Perspective of Recovery”.   Much of the day focussed on improving outcomes, an interactive session on the post anaesthetic care unit, inflammation, pain, and cutting edge advances with an undoubted highlight  being The Henrik Kehlet lecture, brilliantly delivered by Professor David Jayne from Leeds, UK, entitled “Does New Technology Improve Surgical Outcomes?” In addition, it is uplifting to see high ongoing high quality new research, with presentations of the best six abstracts. The final day, Friday 3rd May, focussed on patient partnership,  “where are the problems? ” and current dilemmas. A popular session was “whose patient is it anyway” with two surgeons and two anaesthetists debating with a blend of intellect and humour a topical issue. The prestigious Ken Fearon Lecture entitled “Reducing Variation to Improve Outcome” given by Professor Rupert Pearse from London, UK, was a fantastic analysis of the importance of consistent care. Six excellent rapid-fire presentations were also delivered.   The congress ended with presentation of prizes as follows: Rapid fire prize (€200): OR09 - R Pickens - Vertical Compliance: A novel method of reporting patient specific ERAS compliance for real-time risk assessment Best oral presentations: First prize (€500) OR02 - K Rollins Goal directed fluid therapy using trans oesophageal Doppler in patients undergoing elective colorectal surgery: A meta-analysis of randomised controlled trials. Second prize (€300) OR01 - L Halliday Adherence to exercise during rehabilitation: The relationship with changes in fitness and post-operative pneumonia.   As always it is good to see familiar faces and meet new delegates. Of particular note is the fusion of new ideas, together with the friendliness and informality that enabled younger members to have a relaxed chat to some of our very well-known delegates. Full details of the Congress and our sponsors can be found  here.  Also, follow us on twitter @ErasSociety, we have increased our followers by about 1000 from last year to nearly 2700. We had very good twitter activity with over 200 individuals sending over 1000 tweets and using #ERAS2019, in all reaching over a quarter of a million people! Finally keep an eye for photos from the Congress which will be posted on the website the coming months. We offer our sincere thanks to all involved in the delivery of an outstanding meeting, in particular the Congress President Nader Francis and his organising Committee, as well as our organising committee, the speciality group chairs and the ERAS® executive committee. In addition, many thanks go to our sponsors and our excellent congress planers, MCI Suisse. Already we are planning the 8th ERAS® World Congress and will update you all when the details are finalised. We can then very much look forward to welcoming you and your teams!   Professor  WJ Fawcett May 2019 ### Update following the publication of the ERAS Guidelines for Cardiac Surgery ERAS Colleagues, We are pleased to share our: Guidelines for Perioperative Care in Cardiac Surgery:  Enhanced Recovery After Surgery Society Recommendations published in JAMA Surgery. Our release of this landmark manuscript was announced during the recent American Association for Thoracic Surgeons on May 4th.  It contains graded recommendations for 22 subjects that can be considered to enhance recovery after cardiac surgery and was endorsed by the Enhanced Recovery after Surgery Society®.   Upon publication in JAMA Surgery, it has been viewed over 15,000 times in the first 10 days, making this one of the most viewed articles ever in this journal. It has an Altmetric score placing it in the top 1% of "attention scores" of all published manuscripts.  We are very pleased it has been so well received, and thus wanted to share it with each of you.  You can download the article from JAMA surgery without cost here. We would also like to share our latest ERAS Cardiac Newsletter. Thank you for your interest and continued support of the non-profit ERAS® Cardiac Society.  We look forward to future collaboration, meetings, and publications. Please visit our website for updates and further information, The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) mission is to optimize perioperative care of cardiac surgical patients through collaborative discovery, analysis, expert consensus, and dissemination of best practices.   Cheryl Crisafi, MSN, RN, CNL, ERAS Cardiac Clinical Coordinator and Daniel Engelman MD, FACS, President, ERAS® Cardiac ### ERAS Society Guidelines for Cardiac Surgery - Now published and free to download The ERAS Society are delighted that the "Guidelines for Perioperative Care in Cardiac Surgery - Enhanced Recovery After Surgery Society Recommendations" have recently been published in JAMA Surgery. Congratulations to Dr. Engelman and colleagues on their fine work and valuable contribution. The guidelines are available for FREE download here  Link to the ERAS Cardiac chapter website The guidelines have been published alongside an accompanying invited commentary from Prof Olle Ljungqvist titled "Enhanced Recovery After Surgery—Knowing, Not Guessing" which can be accessed here ### Guidelines for perioperative care in gynecologic/oncology - 2019 update The ERAS Society is delighted to announce that the "Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update" have just been published in the International Journal of Gynecological Cancer (IJGC). The guidelines are FREE to download and are available here. They are also listed on our guideline page with all of the other ERAS Guidelines. ### New and updated ERAS Society Colorectal Surgery Guidelines The new and updated “Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018” are now available online by clicking here. View all of the ERAS Society guidelines by clicking here. ### ERAS Society Lung Surgery Guidelines The “Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)” are now available online by clicking here. View all of the ERAS Society guidelines by clicking here. ### ERAS Society Esophagectomy Recommendations The "Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations" are now available online by clicking here. View all of the ERAS Society guidelines by clicking here. ### The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery ERAS Society Scientific Chair: Professor Dileep Lobo ERAS Society guidelines have recommended that mechanical bowel preparation (MBP) should not be used for patients undergoing colonic surgery and that it should be used selectively for patients undergoing rectal surgery. This has been based on the fact that mechanical bowel preparation on its own did not impact on morbidity and mortality in these patients when compared with no bowel preparation or rectal enema alone. This new meta-analysis has looked at the impact of oral luminal antibiotic preparation (OAB) on outcome in patients undergoing colorectal surgery. It has analysed data from both cohort studies (12 studies, 63,080 participants) and randomised controlled studies (28 studies, 6,437 patients). Although the addition of cohort studies may be considered to weaken the strengths of the conclusions, there have been a number of recent large cohort studies and these cannot be ignored. One of the strengths of this analysis is that it includes only one of the many NSQIP studies that have used the same database with overlapping cohorts of patients. Separate analyses have been presented for cohort and randomised controlled studies. The meta-analysis has shown that a combination of MBP+OAB versus MBP alone was associated with a significant reduction in surgical site infection rates, anastomotic leak, 30-day mortality, overall morbidity and development of postoperative ileus, with no difference in Clostridium difficile infection rates. When a combination of MBP+OAB was compared with OAB alone, no significant difference was seen in SSI or anastomotic leak rates, but there was a significant reduction in 30-day mortality, and incidence of postoperative ileus with the combination. The study also found that there is minimal literature available on the comparison between combined MBP+OAB versus no preparation, OAB alone versus no preparation and OAB versus MBP. Whilst evidence arising from large retrospective cohort and database studies suggests a strong positive benefit, these are tempered when evidence arising from randomised controlled trials alone is considered. However, the evidence from randomised controlled trials suggests a benefit from OAB preparation in terms of SSI, which represents a major source of morbidity and increased healthcare costs. The study suggests a potentially significant role for OAB preparation, either in combination with MBP or alone, in the prevention of postoperative complications in elective colorectal surgery, and perhaps, this may need revisiting the ERAS guideline recommendations. Click here for the article. Professor Dileep Lobo University of Nottingham, UK   ### Recovery after surgery: time to break with tradition Nurses Section Chair: Angie Balfour, RN A new article has just been published in the Nursing Standard featuring ERAS Society Nurse Section Chair, Angie Balfour. Pearce ,L.(2018).Recovery after surgery: time to break with tradition. Nursing Standard, 33(6), 70-72.doi:10.7748/ns.33.6.70.s27 Click here for the full article ### Save The Date! ERAS USA 3rd Annual Congress Save The Date for the ERAS USA 3rd Annual Congress, to be held in New Orleans, on 14-16 Nov 2019. ### Report from the SwERAS Conference 2018 The second annual SwERAS conference was successfully held in November 2018, with 110 participants from a variety of professions and medical specialties. Twentyfour different hospitals, from three countries, were represented. The sessions included a broad variety of topics. There was an in depth discussion after a large survey concerning practical implementation of the ERAS program for colorectal surgery. There were two inspiring examples from ERAS - hospitals in Sweden and Norway. The University Hospital of Sahlgrenska in Gothenburg presented there work with enhanced recovery after pancreas surgery. Östfolds hospital in Norway had a presentation of there way to achieve low complicationrate, short length of stay and high compliance to ERAS. One session highlighted the importance of identifying, and special preoperative workup, for the high risk patients. With the Swedish SPOR registry as a base we had a number of lectures concerning the danger of surgery in a metabolic, respiratory, cardiac and mentally perspective. Validation of the EIAS database is vital for extraction of correct data. Both for benchmarking within each hospital and for future research. SwERAS is therefore planning for a national validation program, during 2019, of each Swedish hospital that participates in an ERAS program. One highlight of the two days was our guest speaker professor Nicolas Dermartines, University Hospital of Lausanne, Switzerland. He addressed the challenges of ERAS in liver and pancreas surgery on the first day of the conference, and both a historical and futuristic view on the subject: From surgical technique to ERAS, on the second day. There was also plenty of time at coffee breaks and at lunch to network with other colleagues and get practical tips and tricks how to implement and how to maintain the ERAS spirit. The 3rd SwERAS conference will be held in Stockholm on the 21 - 22 of November 2019. Welcome! Lars Johansen ### ERAS® Society & ERAS® Society Latin America sign partnership with the Brazilian Society of Anesthesiology and São Paulo State Society of Anesthesiology From left to right: Dr. Othon Bastos (President of São Paulo Society of Anesthesiologists), Dr. Sérgio Logar, (President of Brazilian Society of Anesthesiologists), Dr. Hans de Boer (Treasurer of ERAS® Society) and Dr. Adrian Alvarez (President of ERAS® LATAM). At the recent 65th annual Congress of the Brazilian Society of Anesthesiologist in Belem, Brazil, a memorandum of understanding was signed between the Brazilian Society of Anesthesiology, São Paulo State Society of Anesthesiology, the ERAS® Society and the ERAS® Society Latin America. Dr. Othon Bastos (President of São Paulo Society of Anesthesiologists) and Dr. Sérgio Logar, (President of Brazilian Society of Anesthesiologists) signed on behalf of their societies. The objective of this collaboration is to define joint strategies in order to promote perioperative care in Brazil in line with the best scientific evidence-based medicine practices according to the ERAS® Society methodology. Furthermore, we have agreed to extend collaboration between the societies in the field of education and scientific research according to the operational guidelines of the ERAS® Society. We are looking forward to this new international collaboration. Adrian Alvarez, ERAS® Society Latam Chapter Hans de Boer, Eras® Society ### New Textbook - Analgesia in Major Abdominal Surgery A new textbook edited by Prof Michael Scott and Dr Anton Krige presents the current evidence in an Enhanced Recovery Programme context, and provides a common sense approach to using the array of available analgesia techniques appropriately in major abdominal surgery. Current pain relief options are discussed, many of which have been described only in the last ten years. Topics covered range from the now widespread use of portable ultrasound machines to an appreciation of the value of some older drugs in a new context. Analgesia for Major Abdominal Surgery is aimed at anesthetists, acute pain teams, and acute pain nurses, as well as colorectal, hepatobiliary, urological and gynecological surgeons. Click here to see more details on the Springer website ### Mayo Clinic 4th Annual Enhanced Recovery After Surgery Course 2019 Join Dr. Tonia Young-Fadok and colleagues for the upcoming CME conference entitled “Mayo Clinic 4th Annual Enhanced Recovery After Surgery Course 2019”,  on February 22-23, 2019, in Phoenix, AZ US. For overview, programme, registration, and all the details click here    ### ERAS in Mexico Last August 11th, 2018 we received at the National Cancer Institute, Mexico, Dr. Adrián Álvarez and Nurse Gabriela Sánchez from Hospital Italiano de Buenos Aires. The objective was to start our training to implement ERAS in our Digestive Tract Tumors Department.  We counted with the presence of the Associate Medical General Director of our Institution, Dr. Ángel Herrera Gómez, and Vice-Director of Surgery, Dr. Aarón González Enciso. For the implementation of this program we created a team in each area that this program will be implemented, the Colorectal team, coordinated by the Head of the Department, Dr. Horacio López Basave and the Pancreatic surgery team coordinated by Dr. Javier Melchor Ruan.  With a total of 20 attendants the training started in the morning discussing the goals of the ERAS program and stating which is the necessary process for its implementation. Doubts about how to manage changes in the perioperative process of the patient were clarified and each team set its short- term goals. We had the first contact with EIAS system and we defined activities for the first two months. With great enthusiasm we started our training counting with the active presence of Nurse Mariana Perales; authorities of the Nurse Department of the Institution as well as representatives of the Anesthesia and Nutrition Departments, associate physicians and residents. Dr. Javier Melchor Ruan- ERAS INCAN Program Coordinator Top Row - left to right: Crisenry Brito Baños- Anesthesiologist, Luis Cuellar- Head of Anesthesia Department, Abraham Fabela- Anesthesiologist, Luis Orozco Rosas- Surgery resident, Maura Judith Tomas- Anesthesiologist, Sergio Aguilar- Oncologic Surgery resident, Gerardo Miranda: Pancreatic Associate surgeon, Aarón González Enciso: Surgery Vice Director, Javier Melchor : ERAS Program Coordinator, Itzel Vela Sarmiento: Associate Colorectal Surgeon, Mariana Perales: ERAS Program Nurse Coordinator, María Josefina, Flores: Nutritionist, Anabel Labana - Nutritionist, Alberto León : Associate Colorectal Surgeon Bottom row - left to right: Emma Ávila García: Surgery Nurse Supervisor, Inés Mendoza Santos: Head Nurse, National Cancer Institute, Horacio López Basave: Head of Digestive Tract Tumor Department, Adrián Álvarez, Juan Manuel Ruiz: Surgical Coordinator, Erika Gonzalez Soriano: Surgery Head Nurse           ### The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies NEW PUBLICATION ALERT! Click here to access this new publication produced by members of the ERAS Society.   Elias KM, Stone AB, McGinigle K, Tankou JI, Scott MJ, Fawcett WJ, Demartines N, Lobo DN, Ljungqvist O, UrmanRD; ERAS® Society  and ERAS® USA (2018) The Reporting on ERAS Compliance, Outcomes, and Elements Research (RECOvER) Checklist: A Joint Statement by the ERAS® and ERAS® USA Societies. World J Surg. 2018 Aug 16. doi: 10.1007/s00268-018-4753-0.  "The RECOvER Checklist is intended to provide a standardized framework for the reporting of ERAS related studies. The checklist can also assist reviewers in evaluating the quality of ERAS-related manuscripts. Authors are encouraged to include the RECOvER Checklist when submitting ERAS-related studies to peer-reviewed journals." ### 8th ERAS UK Conference, 16th November 2018, Heathrow Airport, London, UK. This year ERAS UK are arranging this conference in partnership with Macmillan Cancer Support and will be focussing on the optimisation of treatment and recovery, throughout a cancer patient's journey.       At the end of this event, participants should be able to: Describe the impact of prehabilitation on the treatment of cancer patients Discuss the new developments in anaesthesia and perioperative care for cancer patients Explain the innovative approaches used for prehabilitation in primary care Debate the challenges for prehabilitation of cancer patients within the regulated waiting times Consider the recent innovations in ERAS practice across the UK Describe the current best practice for optimising patient condition through palliative chemotherapy Reflect on the various models of prehabilitation that exist at different centres in the UK Explain the links between prehabilitation and cancer commissioning priorities For all the details on programme, speakers, and how to register, click here ### 3rd Singapore Enhanced Recovery after Surgery Symposium, 22 September 2018, Singapore. Join ERAS Society Chairman Prof Olle Ljungqvist and colleagues from Singapore, for the inauguration of the ERAS Chapter Singapore, and a one day symposium in ERAS. Full details of the programme and how to register are available here.here ### 3rd ERAS Philippines Annual Congress, 28-29 September 2018, Manilla, Philippines. The ERAS Society is delighted to announce the 3rd ERAS Philippines Annual Congress. World leading experts will provide and update on new trends and best practice in the optimisation of surgical care. The full programme is available here. You can register for the event here.  ### 1st World Congress on Enhanced Recovery After Surgery in Pediatrics The 1st World Congress on Enhanced Recovery After Surgery in Pediatrics, will be held on November 30 – December 1, 2018, at the McGlothlin Medical Education Center, 1200 East Marshall Street, Richmond, Virginia, United States of America. This inaugural event will bring together experts in surgery, anesthesia and medicine to discuss the pediatric-specific implications of developing an enhanced recovery after surgery program. A full one and a half days are devoted to lectures and discussions related to current pediatric ERAS programs and will provide a platform for collaboration on future projects related to ERAS outcomes around the world. Click here to download the full programme and details of how to register ### Podcast - What’s the relationship between Enhanced Recovery after Surgery (ERAS) and Prehabilitation? In this podcast, Prof Mike Grocott, interviews guests; Olle Ljungqvist, Prof. of Surgery, MD, PhD, Surgeon, Örebro University Hospital & Karolinska Institute, Sweden Franco Carli, Prof. MD, PhD, Anesthesiologist, McGill University, Canada. They discuss the relationship between Enhanced Recovery after Surgery (ERAS) and Prehabilitation, and their highlights of the recent prehabilitation conference in Eindhoven. Click here ### World Journal of Surgery is now the official publication of the ERAS Society The ERAS Society is delighted to announce that the World Journal of Surgery (WJS) has become the official journal for society.  This new relationship, and the mission of the ERAS Society very much fits the mission of the WJS, which is to promote innovation and discovery that helps to improve patient outcomes on the international stage. Sosa, J.A. & Ljungqvist, O. World J Surg (2018). ### Professor Kenneth Fearon Memorial Cancer Cachexia Symposium On the 6-7th September 2018, the Professor Kenneth Fearon Memorial Cancer Cachexia Symposium will be held at Edinburgh University. As well as being a pioneer in the field of ERAS, Prof Fearon was as a leading light in the field of cancer cachexia, with over 170 peer-reviewed publications focused on the topic. For more details on the symposium click here ### New delphi study from ERAS experts - a consensus on training and implementation of ERAS Congratulations to Prof Nader Francis and colleagues on their recently published Delphi study looking to provide a consensus on training and implementation of Enhanced Recovery After Surgery. Effective ERAS training courses must cover the evidence-based principles of ERAS with team-oriented training, and successful implementation of ERAS requires strong leadership, an ERAS facilitator and an effective MDT. Click here to read the full article in the World Journal of Surgery. ### Report on the 6th ERAS® World Congress The 6th ERAS® Society World Congress was held at the Clarion Sign Hotel, Stockholm, Sweden, from the 23rd – 25th May 2018.  Enjoying beautiful spring sunshine, the Congress was our most successful to date. The international standing of the Society was confirmed attracting 585 delegates worldwide. Whilst the majority came from Europe (73%), over 11% of delegates came from both North America and Asia, with smaller numbers from Oceania (2%), South America (2%), and Africa (<1%). Locally we had very strong support, attracting 137 Swedish delegates.   This was easily the best attended Congress to date with a nearly 50% increase in numbers from Lyon in 2017 (393) and Lisbon in 2016 (389). We also surpassed the numbers in Washington in 2015 (492) - which was a combined meeting with EBPOM and ASER. These delegate numbers reflect the growing worldwide interest for ERAS®. We also had 13 abstracts selected for oral presentation and 102 poster presentations (all published in Clinical Nutrition ESPEN 2018;25:166-209 with a link to the abstracts here).   On 23rd May, there was the ever-popular ERAS® course where delegates learnt about the relevant pathophysiology and perspectives from different healthcare professionals – surgeons, anaesthesiologists and nursing.  In addition, clinical audit and speciality-specific areas were covered. There were also a number of other symposia – cardiac surgery, women’s health/gynecology, urology, nursing and AHP meeting during this first afternoon. A major highlight of the day was the official joining of ERAS® Cardiac Surgery to the ERAS® Society.   The Scientific Programme began on 24th May and following addresses by both the ERAS® Chairman,  Professor Olle Ljungqvist and Professor Anders Thorell (Congress Chairman), new frontiers were discussed. A highlight was The Ken Fearon lecture, delivered by Professor Luca Gianotti, from Monza, entitled “Critical aspects of clinical trials in surgery and ERAS”.   The majority of this day focussed on new ERAS® frontiers (thoracic surgery, emergency laparotomy, pediatric surgery and cardiac surgery), perioperative anaemia, the challenging ERAS patient (diabetes, mobilisation with paraplegia, dementia and substance abuse) and the difficult problem of postoperative ileus also discussed. A popular session was the interactive discussion about complex cases. The day ended with presentations of the best six abstracts.   The final day’s highlight was The Henrik Kehlet lecture, delivered by Professor Pierre-Alain Clavien from Zurich, entitled “New concept of benchmarking in surgery”, tracing the evolution of Clavien-Dindo classification into the Comprehensive Complication Index (CCI).  Other sessions included experts discussing epidurals versus wound catheters, delayed gastric emptying, bowel preparation, and barriers to the adoption of ERAS® worldwide. One area that has received little attention to date is what to do with the ERAS® patient after discharge from hospital? An entire session was devoted to this with presentations on nutrition, thromboprophylaxis, exercise training and structured nursing follow-up. The concepts of ERAS® and survival – both long and short term - and patient partnership were also discussed. Seven excellent rapid-fire presentations were also delivered.   The congress ended with presentation of the best paper prize to:   THE EFFECTS OF BETA-BLOCKER THERAPY ON EARLY MORTALITY FOLLOWING EMERGENCY COLON CANCER SURGERY  Rebecka Ahl 1, Peter Matthiessen 1, 2, Xin Fang 3, Yang Cao 1, 3, Gabriel Sjölin 1, 2, Rickard Lindgren 2, Olle Ljungqvist 1, 4, Shahin Mohseni 1, 2 1 School of Medical Sciences, Örebro University, 2 Department of Surgery, Örebro University Hospital, Örebro, 3 Institute of Environmental Medicine, 4 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden   And the best rapid fire presentation to:   RISK FACTORS FOR DELAYED GASTRIC EMPTYING AFTER PANCREATICODUODENECTOMY AND NEED FOR ENTERAL FEEDING ACCESS IN THE ERAS® ERA William B. Lyman 1, Michael Passeri 2, Russell C. Kirks 1, Allyson Cochran 2, John B. Martinie 2, Dionisios Vrochides 2, Erin H. Baker 2, David A. Iannitti 2. 1 Department of Surgery, Carolinas Medical Center, Charlotte, United States; 2 Division of HPB Surgery, Carolinas Medical Center, Charlotte, United States   What were the highlights? The two keynote lectures were, as always, enthralling. The wealth of excellent research is always heartening as superb worldwide talent is taking ERAS® forward. The satellite symposia? The ERAS® Course? The many excellent lectures? The joining of ERAS® Cardiac Society?   Full details of the Congress and our sponsors can be found here. Also, follow us on twitter @ErasSociety, we have increased our followers to nearly 1700! We had very good twitter activity with over 175 individuals sending over 800 tweets and using #ERAS2018, in all reaching nearly a quarter of a million people! Finally keep an eye for interviews and photos from the Congress which will be posted on the website the coming months.   We offer our sincere thanks to all involved in the delivery of an outstanding meeting, in particular the Congress President Anders Thorell and his local organising Committee, the speciality group chairs and the ERAS® executive committee. In addition many thanks go to our sponsors and our excellent congress planners, MCI Suisse.   Already we are planning the 7th ERAS® Society World Congress which will be held at the Liverpool Arena and Convention Centre (ACC),UK, May 1-3, 2019. Please make a note of the date and we very much look forward to welcoming you and your teams there!   Dr WJ Fawcett June 2018 ### ERAS World Congress abstracts now published in Clinical Nutrition ESPEN Congratulations to all those who are presenting papers at the 6th ERAS World Congress in Stockholm. Your papers have now been published in Clinical Nutrition ESPEN. Click here to view online ### Live Urological Surgery Symposium hosted by Dr Yannick Cerantola Dr Yannick Cerantola (Urologist and Chairman of the ERAS Urology Chapter) and his team are organising a live surgery symposium on Monday 28th May 2018, in Lausanne, Switzerland. The aim of this masterclass is to demonstrate how the application of ERAS protocols, deep neuromuscular blockade and enhanced surgeon-anesthetist interaction can benefit a patient's recovery through a live urological procedure.  Click here for all for the details ### ERAS Society - Executive committee and appointed officers Ahead of the World Congress next week we have updated our website. Short biographies and photos are now provided for the executive committee and appointed officers who run the day-to-day businesses of the society. Click here to view the Committees page We look forward to meeting both new and old friends in Stockholm next week. ### Save the date! First World Congress on ERAS in Pediatrics - 30 Nov 2018, Richmond, Virginia, USA ### Successful First ERAS Society Turkey Congress   ERAS Society Turkey, the national ERAS Society for Turkey was officially formed in 2017. Last week, May 3-5, the first ERAS Society Turkey congress was held in Ankara under the leadership of Prof Haldun Gundogdu. More than 370 enthusiastic delegates from around the country attending the 3 day event. Surgeons, Anesthetist, nurses and other allied health professionals attended this multi professional multi disciplinary congress. More than 90 abstracts had been submitted. Invited speakers from abroad were professor Henrik Kehlet (DK) and Dr Medhat Slabi (Dubai) and from the ERAS Society Prof Olle Ljungqvist (SE) and ERAS nursing group lead Angie Balfour. In conjunction with the meeting Olle Ljungqvist ERAS Society and Haldun Gundogdu the Turkish sister organization signed the collaboration agreement to have the national society represent the ERAS Society in Turkey. Plans for a fast development of Centers of Excellence to help spread the ERAS principles across Turkey. Olle Ljungqvist & Haldun Gundogdu ### ERAS Cardiac Surgery Named Official Heart Surgery Representative for ERAS Society The ERAS Society is delighted to announce that it has formalized an agreement with ERAS® Cardiac Surgery for them to has to act as the sole official ERAS® Cardiac Surgical Specialty Society representing ERAS® Society on a global level. In addition, the ERAS® Cardiac Surgery has been granted the distinct privilege to propose which hospital(s) should be appointed ERAS® Centers of Excellence in Cardiac Surgery. “The ERAS® Society is very pleased to have added this important surgical discipline to the fast -growing network of specialties around the world.” said Professor Olle Ljungqvist. “The ERAS® Cardiac Surgery Society is a formidable group of experts that will play a pivotal role to develop and implement ERAS for the benefit of the large number of patients undergoing cardiac surgery world wide” Click here for the full press release ### 6th ESPEN Symposium on Perioperative Nutrition The 6th ESPEN Symposium on Perioperative Nutrition will be held on the 14-15 October 2018, at the East Midlands Conference Centre Nottingham, UK. The meeting will be Chaired by ERAS Society Scientific Chair, Prof Dileep Lobo, and will feature a session on ERAS delivered by ERAS Society Chairman, Prof Olle Ljungqvist.  Click here for programme and information ### 6th ERAS World Congress May 23-25, 2018 Dear Colleagues,  We are extremely excited to host you at the 6th ERAS World Congress May 23-25, 2018.  This year we have a terrific line-up of programs and courses prior to the main meeting including those from the ERAS Society Cardiac, Urology, Gynecology and Nursing/AHP groups.  As with previous years we will again be having a comprehensive ERAS Course which will provide an excellent summary of the majority of ERAS components.  For the main ERAS program which runs May 24-25 we have a tremendous group of international speakers who will be providing important updates on ERAS perioperative care and who will also be discussing many of the hot topics and controversies in ERAS.  Be sure to come for the opening session entitled “New frontiers in ERAS” which will highlight the many soon-to-come guidelines in Thoracic Surgery, Emergency Laparotomy, Ambulatory Care, Pediatric Surgery and Cardiac surgery.  Finally, we look forward to hearing from Prof Gianotti and Prof Clavien who will be giving this year’s Fearon and Kehlet lectures, respectively. We look forward to seeing you all in Stockholm!  Sincerely, Gregg Nelson Secretary, ERAS Society   Dr. Gregg Nelson obtained his MD and PhD degrees at the University of Calgary and subsequently continued on to complete his sub-specialization in Gynecologic Oncology at the Tom Baker Cancer Centre in Calgary, Alberta. He is Associate Professor in the Departments of Obstetrics & Gynecology and Oncology at the Cumming School of Medicine and is Chair of the Provincial Gynecologic Oncology Tumor Team. Dr. Nelson's principal research interest is the development and study of enhanced recovery protocols in surgery. He holds the position of Surgical Lead, ERAS Alberta and he also leads the international group that published the ERAS® Guidelines for Gynecologic/Oncology Surgery. Recently he has been appointed the Secretary of the ERAS® Society Executive Committee based in Sweden. Dr. Nelson has over 75 peer-reviewed publications and has presented numerous times on ERAS® internationally.   ### TED Beacon Street Interview with Olle Ljungqvist In this interview, filmed after his TEDx talk, Prof Olle Ljungqvist explains ERAS, and highlights the importance of multi-disciplinary teams working together. Please share with your colleagues. https://www.youtube.com/watch?v=s8e02Xk5A0w     ### ERAS® Society Website Newsletter March 2018 With just over 2 months to go before the 6th ERAS ® Society Congress in Stockholm, excitement is rising as delegates, speakers, organisers and sponsors prepare for what promises to be a wonderful occasion in one of the world’s most picturesque cities. If you have followed the Society for a while, you will have observed that the website has undergone some marked changes and is a key point of contact for many, especially around our Congress. If you haven’t viewed the website before now, Welcome! We have over 100,000 hits per year from all over the world. Our website is regularly updated with news, reports on meetings and ERAS Society guidelines which are free to download and expert reviews. In addition there are details of your own countries societies websites  and contacts for centres of excellence and details of our interactive audit system Please also follow us on twitter @ErasSociety. We have nearly 1400 followers to date! Also, do please contact us if you have any queries, questions or comments at editor@erassociety.org.  We hope to welcome you to Stockholm in May! Bill Fawcett and Tom Wainwright   Website Editors  ### ERAS Society USA Chapter 2nd Annual Congress - Call for Abstracts The ERAS Society USA Chapter 2nd Annual Congress will be held November 8-10, 2018 at the Royal Sonesta in New Orleans. The ERAS USA Program Committee is now accepting abstracts related to all aspects of enhanced recovery for consideration on the 2nd Annual Congress program. The deadline to submit your abstract is Sunday, June 3, 2018. For all the information click here ### 2nd Prehabilitation World Conference, 27-29 June 2018, Eindhoven, the Netherlands The ERAS Society is pleased to support our colleagues hosting the 2nd Prehabilitation World Conference, which will be held June 27th-29th 2018 in Eindhoven, the Netherlands. The conference will be very relevant for those interested in ERAS, with worldwide experts in prehabilitation, training, nutrition, mental support, perioperative care and outcomes, sharing their knowledge, in order to allow you to start prehabilitation or improve your current program. Click here to visit the conference website for all the details ### Prof Olle Ljungqvist "Improving Surgery By Talking To Each Other" TED talk In his talk Prof Ljungqvist explains Enhanced Recovery After Surgery (ERAS). The talk describes the transformative results from all over the world. Please promote and share within your networks. https://www.youtube.com/watch?time_continue=1&v=bnzRjO1oP0Y   ### ERAS Society at the IHPBA 2018 Congress, 4-7 September 2018, Geneva, Switzerland The ERAS Society is delighted to be a Partner Society at this years IHPBA Congress in Geneva. Prof Nicolas Demartines and Prof Olle Ljungqvist will lead a session on ERAS at the Congress. You can find out more details such as the programme, important deadlines, and details on registration by visiting the Congress website (www.ihpba2018.com). ### ERAS World Congress 2018 - UEMS accredited UEMS ACCREDITATION The ERAS world Congress 2018 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. ERAS 2018 is designated for a maximum of, or up to 17 European CME credits (ECMEC). Each medical specialist should claim only those credits that he/she actually spent in the educational activity. The EACCME is an institution of the European Union of Medical Specialists (UEMS), www.uems.net. Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians may convert EACCME credits to an equivalent number of AMA PRA Category 1 Credits™. Information on the process to convert EACCME credit to AMA credit can be found at  https://www.ama-assn.org/education/earn-credit-participation-international-activities.  Live educational activities, occurring outside of Canada, recognized by the UEMS-EACCME for ECMEC credits are deemed to be Accredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada ### The ERAS Society Executive Committee is expanding The ERAS Society Executive Committee is introducing a new position: Chairman of the ERAS Implementation Program. This is a fast growing program already available in leading institutions in more than 25 countries on every continent around the world. This is one of the most important missions of the Society, supporting the use of updated evidence based perioperative care giving important improvements in outcomes for an ever growing number of patients worldwide. This program will be further strengthened by the institution of a special group working specifically on issues related to implementation and that is represented at the core of the Society.   Professor Nicolas Demartines and his team from CHUV in Lausanne has world leading experiences in implementation of ERAS around the world, and the Society is very pleased to have him lead this key mission by taking on the position as Chairman of the ERAS Implementation Program. As Professor Demartines is taking on this new position, he leaves the post of Treasurer for the Society where he has successfully served for several years and on behalf of the Society I thank him for his excellent, devoted and loyal service to the Society in this position and wish him luck on the new mission.   New Treasurer: Hans de Boer, MD PhD, Consultant Anesthesiologist and Pain specialist from the Martini General Hospital Groningen, The Netherlands is appointed Treasurer of the ERAS Society. Dr de Boer has a long standing academic interest in muscle relaxation during anesthesia and surgery and has published award winning work in this field. He has lead his team in Groningen to a very successful implementation of ERAS and is currently the lead of an ERAS Center of Excellence. He has many years of experience from involvements in different medical societies both nationally and internationally and it is with great pleasure we welcome him to join the ERAS Society Executive Committee in this important position.   Olle Ljungqvist Chairman ERAS Society Executive Committee ### Abstracts from ERAS nurses and AHPs wanted for ERAS Congress 2018 ERAS is a team effort and we want to encourage and highlight more of the innovative work undertaken by nurses and allied health professionals at our 2018 conference. If you are a nurse, operating department practitioner, physiotherapist, occupational therapist, dietician, pharmacist, radiographer, health care assistant, or any other non-medial professional involved in ERAS, we would love to receive an abstract from you. Full details on how to submit an abstract are here ### The ASGBI International Surgical Congress, Liverpool, 9-11th May 2018 The ASGBI 2018 International Surgical Congress will be held in Liverpool from Wednesday 9th to Friday 11th May 2018. The theme of the Congress is “Surgical Teams”, and is therefore especially relevant to the successful delivery of ERAS. As we know, surgical services are now delivered by multi-disciplinary, multi-professional teams, and that collaborative teamwork has significant benefits in increasing efficiency, improving clinical outcomes, fostering innovation and delivering phenomenal academic and research opportunities. Therefore it is great that the ASGBI have chose this for the conference focus in 2018. For more information click here.   ### Report from the inaugural conference of the Swedish chapter of the ERAS Society - SwERAS 2017 The first annual SwERAS conference was successfully held in November 2017, with 130 participants from a variety of professions and medical specialties. Twenty different hospitals, from three countries, were represented. The lectures included both basic strategies of the ERAS program and a number of inspiring examples from ERAS – hospitals in Sweden. Karolinska Huddinge presented their work with enhanced recovery after esophageal resection. Capio S:t Göran had a presentation of their algorithm concerning high risk patients. Skaraborgs Sjukhus Skövde showed the results from a study where the patients were interviewed about their experience of an ERAS treatment. A short introduction of how to extract information out of the EIAS database was held. Encare is planning for a full day EIAS education during 2018. Validation of the EIAS database is vital for extraction of correct data. Both for benchmarking within each hospital and for future research. SwERAS is therefore planning for a national validation program during 2018 - 2019 of each Swedish hospital that participates in an ERAS program. One highlight of the two days was our guest speaker Professor Mike Scott. He addressed the anesthetist’s role in an ERAS program on the first day of the conference and implications of ERAS on health economy in the care of elderly on the second day. There was also plenty of time at coffee breaks and at lunch to network with other colleagues and get practical tips and tricks how to implement and how to maintain the ERAS spirit. The 2nd SwERAS conference will be held in Stockholm on the 22 – 23 of November 2018. You are very welcome to join us! Lars Johansen ### Message from Professor Olle Ljungqvist, Chairman of ERAS® Society Executive Committee Dear ERAS Friends, The year just passed, 2017 was yet another important ERAS year where ERAS and the ERAS® Society have made some major steps forward, thanks to the important contributions by many excellent ERAS colleagues others around the world. A 5th ERAS World Congress very successfully run in Lyon, and many regional and local events were held around the world. New guidelines in Head and Neck cancer and Breast reconstruction were published and several of the ERAS Guidelines are now available on the ERAS® Interactive Audit System and are now in use in implementation programs across the world. As this is being written, more guidelines are being finalized, and updates of older ones are under way to cover a growing range of surgical disciplines. The ERAS® Society guidelines have huge impact as shown by record high citations (Google shows more than 1000 citations for our top scoring paper, and many guidelines with several hundred citations) and many, many more are downloaded. Several published guidelines are being used on the Societies growing platform for research and development. During 2017 the ERAS® Society research support group started to be formed aiming to build an organization to use the data we are collecting around the world to gain new insights and knowledge. A growing number of Centers of Excellence trained to run the ERAS Implementation Programs are available and starting these programs thereby moving into the second wave of ERAS implementation in several countries.   In Latin America, the ERAS LATAM Society was formed, building the basis for leading centers in a number of countries joining the ERAS® Society network. ERAS® USA held its first and very successful congress in Dallas assembling number of leading centers around the USA. Similarly, the ERAS teams in Manilla and Singapore are moving ahead in Asia with a growing interest from number of neighboring and nearby countries, as well as in Africa. There is more and more interest in joining our ERAS programs from large health care providers both in Europe, the USA and elsewhere, as well as a fast-growing interest from industry to support our work. Given the successes and rapid growth of ERAS in a number of domains we are looking forward to the challenges of 2018 with a few highlight events already scheduled; The 6th ERAS® World Congress May 23-25 in my own home town Stockholm, Sweden. The program is outstanding and can be viewed at the website. A number of national and regional ERAS events are planned as well as a growing number of ERAS Implementation Programs. Please check with your national representative for more information. We have a very exciting time ahead and a mission to develop further - but for now, let me wish you all the very best for the New Year and bid you all welcome to Stockholm! ### Enhanced Recovery After Surgery: Avoiding Complications, Avoiding Opiates 2018, Phoenix, USA Enhanced Recovery After Surgery: Avoiding Complications, Avoiding Opiates 2018 Phoenix, AZ, USA, February 2, 2018 to February 3, 2018 Receive $75 Off - When you register on or before January 2, 2018 ERAS 2018 Course Highlights Enhanced recovery starts with clearly defined preoperative preparation that involves the spectrum of health care team members, including the patient. Intraoperative approaches have the entire scope of the patient’s care in mind including post-op recovery – multimodality pain control, pre-emption of nausea, and fluid management to minimize post-op ileus. Opioid Epidemic - Major Health Care Crisis. This course will directly address how the team caring for the surgical patient can minimize post-operative pain and the need for opiate prescriptions. Post-op order sets and team care optimize patient recovery, convey the experience of accumulated knowledge and minimize complications and hospital stay. Click here for information and registration  ### ERAS Congress 2018 - Nursing & AHP break-out session Calling all nurses and AHPs!  We are now finalising the programme for the ERAS Congress next year so I am looking for suggestions from you about what we could discuss during the Nursing & AHP break-out session. Normally - we invite a few speakers to share their ERAS experiences and normally include a patient perspective during the hour-long session.  We are also looking for volunteers who wish to share their ERAS story with us ? I would ideally like to get AHP’s involved in this meeting so I need some physiotherapists/ dieticians and other specialists to contribute. Please let me know if you have any topics in mind and/ or if you want to share your ERAS experiences with the group. Many thanks Angie Balfour, ERAS Society Nurse and AHP Lead https://erassociety.org/contact/ ### Women’s Health/Gynecology Group Symposium - Stockholm, Sweden May 23, 2018 Join ERAS Society Secretary, Dr Gregg Nelson and colleagues, for a Women’s Health/Gynecology Group Symposium before the ERAS Society World Congress next year. Gregg will be joined by international speakers to provide a comprehensive half-day symposium. ERAS Stockholm 2018 Women's Health Gyn Programme ### Abstract submission open for ERAS Symposium in Houston, Texas, USA. Feb 12-13, 2018. Enhanced Recovery After Surgery Symposium: Implementing Change and New Standard of Care in Surgery February 12-13, 2018, Houston, Texas, USA. The 2018 ERAS Symposium invites the submission of abstracts regarding any subject related to the implementation and outcomes of Enhanced Recovery or Fast Track Programs.  The topics of the abstracts may include; but not limited to, topics related to anesthesia, surgery, nursing, nutrition, pain management, prehabilitation, or patient reported outcomes associated with an ERAS Program. Deadline for Abstract Submission is December 1, 2017. Authors may submit abstracts of completed work, work in progress, or work elsewhere within the past 12 months.    Abstract Submission Instructions: Abstracts will only be accepted electronically and should be emailed to ERAS2018@mdanderson.org     The deadline for receipt of abstracts is 11:59 PM CST on Friday, December 1, 2017.  Notification of acceptance for poster presentations will be acknowledged by e-mail by Friday, December 15, 2017.   Abstract Formatting Instructions: Limit abstracts to one page, type in 12-point Times New Roman font, single spaced with one-inch margins, and left justified.  Organize the abstract into:  Background, Methods, Results, and Conclusions.  Define all abbreviations.  Include the abstract title, full names, and institutional affiliations of all authors, and e-mail address of the corresponding author at the top of the abstract.  Underline the name(s) of the presenting author(s).  Abstracts must not contain copyrighted material unless permission has been obtained by the author/publisher.   All presenting authors listed on the abstract are required to register for the conference in addition to submitting an abstract. Click here to register for this exciting educational opportunity! ### Report from the 2nd Singapore ERAS Society Symposium The 2nd Singapore ERAS Society Symposium successfully concluded on 28th September 2017. It was jointly organized by Tan Tock Seng Hospital and the ERAS Society. The focus of this year's symposium was on the core ERAS principles and subspecialty implementation. The response was overwhelming, with more than 200 participants, and the discussion was robust and lively. We were honoured to have Professor Olle Ljungqvist, Professor Dileep Lobo and Dr Marianna Sioson as guest speakers at the symposium. This year, in addition to local participants, there was also keen interest from regional countries like Malaysia, Hong Kong and Indonesia. The symposium was also streamed live to more than 15 countries around the world, including countries in North America, Europe, Asia and Oceania. We look forward to forming the Singapore ERAS chapter and the 3rd Singapore ERAS Symposium next year! ### ERAS Society World Congress 2018 - Abstract submission now open! The ERAS Society are delighted to announce that the 6th ERAS World Congress will be held in Stockholm, Sweden, on the 23-25th May 2018. Abstract submission is now open! Click here to submit Abstract Submission Guidelines 2018 Scientific Programme ERAS® Society Education Course Programme   ### ERAS in Latin America - ERAS Society Symposium at the Latin America Society of Anaesthesiology Congress Professor Adrian Alvarez, who is the ERAS Society Latin America Implementation Lead, will host a one day symposium on ERAS at the XXXIV CLASA, from October 8 to 11, 2017, at the Convention Center of the Conrad Punta del Este Resort & Casino in Uruguay. Conference website Registration Programme https://youtu.be/q6giTNpsLYw   ### SwERAS - Swedish Chapter of the ERAS Society Conference, 23-24 November 2017, Stockholm, Sweden. SwERAS will hold their first annual conference in Stockholm this November. Click here for the Conference Programme Location: Hotell Norrtull, Stockholm Registration: kristina.wikander@erassociety.org Cost: 1.000 kr   ### ERAS Society Philippine Chapter, 2nd Annual Congress, September 29-30, 2017, Manilla. The Enhanced Recovery After Surgery (ERAS) Society Philippine Chapter will be holding its 2nd Annual Congress on September 29-30, 2017, at The Medical City’s Centre for Advanced Skills, Simulation and Training Innovation (CASSTI) and Crowne Plaza Manila Galleria, Ortigas Avenue, Quezon City, consecutively. This year’s theme is: From Principle to Practice (P2P). With the overwhelming success of last year’s congress, we are holding a 2-day activity with a bigger venue to accommodate more attendees. Like last year, we expect the group of surgeons, obstetricians, orthopaedic surgeons, anesthesiologists, pain specialists, internists, nutritionists, nurses, and hospital administrators to be participants in this event. Indeed, the benefits of the ERAS program have opened the eyes of health practitioners worldwide to this changing paradigm. The congress will not only highlight talks from experts from the local ERAS Centre of Excellence, but also from ERAS Society International and the Singapore Chapter. Click here for programme Click here to register ### 2nd Singapore ERAS Symposium - 28th September 2017 The ERAS Society is proud to jointly organise The 2nd Singapore ERAS Symposium along with colleagues from the Tan Tock Seng Hospital in Singapore. The symposium will be held on the 28th September 2017. Click here for the programme. Click here for registration.  ### Save the date! Enhanced Recovery After Surgery Symposium, Houston, Texas. The University of Texas MD Anderson Cancer Center and the ERAS Society invite you to attend the "Enhanced Recovery After Surgery Symposium: Implementing Change and New Standard of Care in Surgery". To be held on 12-13 February 2018, at the The University of Texas MD Anderson Cancer Center, Dan L. Duncan Building (CPB), Floor 8, Houston, Texas, USA. For further details and registration form please click here ### Save the Date! ERAS USA 1st Annual Meeting Save the Date for the ERAS USA 1st Annual Meeting. To be held at the Intercontinental Dallas, Dallas, Texas, November 10-11, 2017. http://erasusa.org/Annual-Meeting.cgi ### Report on a hugely successful 5th ERAS® World Congress The 5th ERAS® World Congress was held between 10th-12th May 2017, at the Centre De Congres, Lyon, France. As in previous years, it consisted of the ERAS® Course followed by the Scientific Programme. Throughout the Congress, they were many excellent lectures from experts from around the World including Europe, North America and Asia. The ERAS® course was again a popular event and sold out with the delegates learning about the relevant physiology underpinning the concepts of ERAS®, viewed from many perspectives – surgeon, anaesthesiologist, nurse, manager and of course, the patient. This year it was condensed into an afternoon course. There was a step by step approach to implementation of ERAS® process and the evidence behind the many elements of care that make up modern ERAS® process, including not only the immediate perioperative steps, but also the importance of preoperative patient education and postoperative audit and quality maintenance. There were also separate specialist talks on Gynaecology, Urology and Orthopaedics. The same afternoon there were specialist group symposia for Urology, Women’s Health and Nursing, all of which proved very popular. The Scientific Programme started the next day, with a session devoted to the pathophysiological basis of ERAS, addressing key areas of the stress response and how it can be modified, opioids and cancer free survival with other aspects of pain control. The difficult areas of fluid therapy and nutrition were also discussed. The prestigious Henrik Kehlet Lecture by Professor Greet van den Berghe from Leuven, entitled The role of autophagy in the metabolism and outcomes after surgery gave a scholarly insight into postoperative pathophysiological processes The afternoon session had well attended sessions on New Themes in ERAS®, Recovery beyond the hospital and Strategies for the ER implantation. The day closed with 6 excellent abstract research presenations, following which there was a highly enjoyable drinks reception, where everyone was able to network, view posters and meet with our sponsors. The second day of the Congress began with How ERAS® will change the Future, followed by a session entitled: Do the Guidelines Work? The Transition from theory to Practice. Following coffee there were two popular debates: Bowel Preparation is unnecessary in Colon and Rectum Surgery (proposal agreed) and Epidural Analgesia is obsolete within ERAS programmes (proposal rejected). The morning session closed with 6 ‘rapid fire’ oral research presentations. The afternoon session started with Ken Fearon lecture, in memory Co-founder and Chairman of the ERAS Society Board, who sadly died last September (https://erassociety.org/wp-content/uploads/2016/09/Ken-Fearon.pdf)  In fitting memory, Professor Alessandro Laviano, from Rome,  gave an outstanding and indeed fitting tribute to Ken entitled Cachexia and the long-term outcome of surgical cancer patients. Even for those not fortunate enough to have met Ken it was still a very poignant and moving session. The Congress concluded with a session on reducing risks, followed a concluding lecture by our ERAS society Chairman Professor Ljungqvist entitled the ongoing surgical revolution, with the last ten minutes devoted to Professor Ljungqvist and our Scientific Chairman Professor Dileep Lobo award prizes to  Dr Nicolò Pecorelli, wining  the Rapid Fire Presentations entitled Does The Risk Of Postoperative Complications Affect The Adherence To Enhanced Recovery Pathways After Pancreaticoduodenectomy?, and Mr Nader Frances for the best abstract entitled Can Hydrogen Breath Test Predict Postoperative Ileus Following Laparoscopic Colorectal Surgery And Within ERAS Programme? What were the highlights of the Congress?  It is impossible to say with nearly three days with world experts, an enthusiastic and engaged delegates and talented researchers all meeting to exchange experiences. Certainly, the Henrik Kehlet and Ken Fearon Lectures were outstanding. In addition, the presentation of new and original work and ideas is always a very exciting and were of a very high standard this year, for it is with these talented researchers that the evidence base which underpins the future success is fundamental for ERAS®. The loss of Professor Ken Fearon was palpable at times, yet the legacy of the society he co-founded with Professor Olle Ljungqvist lives on as a fitting tribute to a great man. The huge success of the Congress is made possible only by the hard work of the Organising Committee and the Local Committee, to whom we express our sincere gratitude. In addition, we are most grateful to the sponsorship we receive from industry and the expert assistance from MCI. The 6th ERAS® World Congress is already being planned for Stockholm from May 23rd to May 25th 2018 and we look forward to welcoming you and your teams there!               ### ERAS Society YouTube channel The ERAS Society YouTube channel has recently been updated with archive presentations and interviews from previous conferences. World leading experts share their insights, experience, and research on a range of ERAS topics. The ERAS Society YouTube channel. https://www.youtube.com/watch?v=9Pf0rswsFFw   ### World Congress - Thursday 11th May 2017 The scientific programme of the 5th ERAS World Congress commenced on Thursday 11th May 2017 with 400 delegates attending sessions on The pathophysiological basis or ERAS The role of autophagy in the metabolism and outcomes after surgery New themes in ERAS Recovery beyond the hospital Strategies for the implementation of ERAS - Lesson learnt Best abstracts Remember to follow updates of the congress via the ERAS Society twitter account @ErasSociety Clinical Nutrition - Abstract Book 2017 ERAS Final Programme ### Abstracts from the 5th ERAS World Congress published in Clinical Nutrition ESPEN All of the accepted abstracts have been published online by Clinical Nutrition ESPEN. Clinical Nutrition - Abstract Book 2017 Web link ### ERAS Society World Congress - Wednesday 10 May 2017 The 5th ERAS World Congress started on Wednesday 10th May 2017 with over 200 delegates attending the pre-Congress Educational Course, the Urology Group Meeting, the Gynecology Group Meeting - Women's Health Symposium, and the ERAS Nursing Group Meeting. Afterwards delegates enjoyed the Welcome Reception by networking with international colleagues and viewing the accepted peer-reviewed posters. Remember to follow updates of the congress via the ERAS Society twitter account @ErasSociety ### Final ERAS Congress Programme now available for download We are looking forward to welcoming you to The ERAS Society World Congress 2017, which will start on Wednesday 10th May in Lyon, France. Final Programme Congress information    ### Just published! "ESPEN guideline: Clinical nutrition in surgery" These guidelines cover the nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. Click here to view the guidelines   ### Just published! ERAS Consensus Review of Optimal Perioperative Care in Breast Reconstruction New ERAS guidelines for Breast Reconstruction have just been published in Plastic and Reconstructive Surgery. Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations. Congratulations to all of the team involved in producing the guidelines.   ### Fresenius Kabi supports the ERAS Society The ERAS Society is happy to announce the following: Fresenius Kabi supports the ERAS Society and its leading academic centres to set up a research support organisation based on the ERAS Interactive Audit System. The ERAS Society is currently advertising for positions for this facility and has several studies in the planning. The Society is grateful for the kind support from Fresenius Kabi for this important project. ### The 7th ERAS UK Annual Conference, 10th November 2017, Newcastle, England. ​This annual event attracts roughly 200 healthcare professionals from across the UK (and a few from overseas).  The 7th ERAS UK conference will feature seminars from centres of excellence, abstract presentations and breakout sessions for various specialties and roles. ​Individuals and groups with an interest in Enhanced Recovery are invited to submit abstracts of their research or service improvement work before Friday 14th July. ​On-line registration for this conference is now open. ​ ### Successful 1st ERAS conference in Colombia We're pleased to announce the first ERAS Colombian Symposium, which was packed with local and international (Dr. Adrian Alvarez from Argentina) ERAS clinical experts. The ERAS Colombia 2017 Symposium was hosted by the XXIV Anesthesiology Course of COLSANITAS Clinics to facilitate local Enhanced Recovery After Surgery (ERAS) best practices. In the meeting held in Bogotá, Colombia, anesthesiology and surgery colleagues and nursing, nutrition and physical therapist professionals, provided stimulating presentations on Saturday, February 18. Topics presented included findings on patients experience and interactive discussions regarding the post-operative care of colonic surgery patients. It was an exceptional opportunity for clinical professionals, key opinion leaders, industry partners and health system administrators, committed to the improvement of perioperative care. Pictured above from left to right Standing: JUAN CARLOS BARRIGA  - GENERAL SURGEON JAIRO BETANCOURT - ANESTHESIOLOGIST ALVARO SARMIENTO - ANESTHESIA DEPARTMENT CHIEF EDUARDO ZARATE - ANESTHESIOLOGIST ERAS LIDER ADRIAN ALVAREZ - ANESTHESIOLOGIST ERAS LATAM LIDER ARNOLD BARRIOS - GENERAL SURGEON CHIEF DEPARTMENT FREDDY MENDIVELSO - EPIDEMIOLOGIST RAUL GUEVARA - GENERAL SURGEON FRANCISCO PETANO - GENERAL SURGERY RESIDENT II JOAQUIN LUNA - GYNAECOLOGY CHIEF DEPARTMENT Seated: DIANA BELLON - PHYSIOTHERAPIST ERAS TEAM VIVIAN PINEDA - ERAS TEAM NURSE IVETTE PEREZ - ERAS TEAM NUTRICIONIST ANGELA NAVAS - ERAS TEAM COORDINATOR LAURA TINOCO  - GENERAL SURGERY RESIDENT I GLORIA FLOREZ  - GENERAL SURGERY RESIDENT II   ### Dr Gregg Nelson appointed as new Secretary of the Executive Committee It is with great pleasure that the ERAS® Society announces the appointment of Dr Gregg Nelson from Calgary Canada as the new Secretary of the Executive Committee. Dr. Gregg Nelson obtained his MD and PhD degrees at the University of Calgary (Alberta, Canada) and subsequently continued on to complete his sub-specialization in Gynecologic Oncology at the Tom Baker Cancer Centre.  He is Associate Professor in the Departments of Obstetrics & Gynecology and Oncology at the Cumming School of Medicine in Calgary and is Chair of the Provincial Gynecologic Oncology Tumor Team.  Dr. Nelson’s principal research interest is the development of enhanced recovery protocols in surgery and he holds the position of Surgical Lead, ERAS Alberta.  Dr. Nelson leads the international group that published the ERAS Guidelines for Gynecologic/Oncology Surgery and is the Chair of the Gynecology Chapter of the ERAS® Society. With the growing presence in North America of the ERAS Society and the excellent experiences from Alberta the Society is particularly pleased to have Dr. Nelson serving at a central position of the ERAS® Society. Olle Ljungqvist, Chairman the Executive Committee ### ERAS Congress 2017 - Programme announced! Visit the ERAS Congress 2017 page to see the newly confirmed programme or use one of the shortcuts below. Join us on 10-12 May 2017 in Lyon, France. Programme Abstract Submission Guidelines Accommodation Congress Registration Details Please click here to register via official online system Sponsors and Exhibitors Information ### Enhanced Recovery After Surgery: A Review in JAMA Surgery On the 11th January 2017, Olle Ljungqvist, Michael Scott, and Ken Fearon published an excellent ERAS review article in JAMA Surgery. The article outlines the rationale for ERAS, details it's implementation across the surgical specialities, the outcomes achieved, the financial benefits, and the future for ERAS. Click here to go to the JAMA website in order to access the article free. Click here to read an expert review of the article by Bill Fawcett. ### ERAS - Gynaecology Webcast Enhanced Recovery: The New Standard for Perioperative Care in Gynaecologic Oncology Join the Webcast live Jan. 16, 2017   We’re excited to present SGO’s first live webcast from the Mayo Clinic on Jan. 16, 2017, at 12 noon Central (GMT - 6:00). If you are not available at this time, as always, you may register for this program on demand. Enhanced Recovery after Surgery (ERAS) is the wave of the future for many specialties, including Gynaecologic Oncology.  Our session on ERAS at the 2016 annual meeting generated much conversation and requests for further education on the subject.  This series will teach you the history, guidelines and tools for implementation of an ERAS program at your institution. Experts in this emerging field will present up to date information and real world experience. Each installment will have a specific focus. January 16, 2017 - Session I: What is ERAS and how can it help us? - Jamie Bakkum-Gamez, MD, Sean Dowdy, MD, and Gregg Nelson, MD History and background of ERAS Generating buy in as a cost saving technique Importance of monitoring protocol compliance Outcomes data Full team engagement April 19, 2017 - Session II: Implementing ERAS, the Nuts and Bolts - Jamie Bakkum-Gamez, MD, Sean Dowdy, MD, and Pedro Ramirez, MD Educating staff and patients on ERAS protocol Managing expectations Data capture Tools for quality improvement Monitoring your program Please join us for this live session, and have your questions answered in real time.  This program is presented through SGO’s Education Portal, Connect Ed. Register here http://sgo.peachnewmedia.com/store/seminar/seminar.php?seminar=87100 ### Updated ERAS reading list Thank you to Dorthe Hjort Jakobsen for updating the bibliography page within the Nursing and AHP section of the website. This is a fantastic resource for all involved in ERAS with a reading list highlighting the key papers in the areas of nursing, patient information, patient and relative satisfaction, and implementation. Click here to go directly to the page. ### ERAS conference in Phoenix, Arizona, USA, 3-4 Feb 2017. Save the date! The ERAS Society USA Chapter will be hosting an ERAS Conference at the Mayo Clinic in Phoenix, on the 3-4th February 2017. ### New ERAS® Society YouTube channel The ERAS® Society now has a new YouTube channel. We will adding content from the archives over the coming weeks including expert interviews, presentations, and congress reviews. If you are thinking about registering for the 5th ERAS® Society World Congress next year in Lyon, check out this video of the 4th ERAS® Society World Congress held in Lisbon earlier this year. https://youtu.be/SHtVi_2D3Ds   ### ERAS Seminar Report - Cape Town, South Africa Eighteen months after registering their first ERAS patient, the team in Cape Town held their first education seminar on Monday 26th September 2016. 73 delegates from four Cape Town hospitals attended the daylong meeting, with representatives from all the professions involved in the ERAS multi-disciplinary team. Thank you to ERAS Nurse Co-Ordinator, Fiona Pieterse for this great report and pictures. ERAS Seminar Report - Cape Town ### ERAS Society official Linkedin group The ERAS Society is proud to announce the formation of our new Linkedin group. Click here to join. ### ERAS Nursing group bids farewell to Dorthe Hjort Jakobsen It is with a heavy heart that we must say farewell to our friend and colleague Dorthe Hjort Jakobsen. After chairing the ERAS Society Nursing Group for several years, Dorthe has decided to step down and concentrate on her role as local improvement facilitator in Denmark. She will continue to keep a watchful eye on the ERAS Society’s work and will remain a useful resource for anyone that needs her advice and support in the future. Dorthe has worked closely with Prof Henrik Kehlet for over the last 2 decades and if Henrik is described as the Godfather or the King of ERAS, then Dorthe is the Queen!! Prof Fearon often referred to Dorthe as “The ERAS Queen!” Her early contribution to the role of the nurse in “Fast-Trak” was instrumental to the development of our current roles as ERAS Nurses. She has presented at numerous national and international conferences and has published several papers within “Fast-Trak” and ERAS care pathways and the role of the nurse within these pathways. She has always been an advocate for multi-disciplinary team working and for the nurse to be recognised as a clinical practitioner whose role was just as important as any other member of the team. The cornerstone of any successful ERAS pathway is the team and Dorthe always strived to promote that. When asked, Dorthe feels very mixed emotions; sad to be stepping down as chair of this group but excited that ERAS programmes are being implemented on such an international scale. She is very proud of the accomplishments the ERAS Nurses have achieved over the last 20 years and she has enjoyed meeting and advising many nurses and teams about “fast-trak” and ERAS programmes since its original inception in the mid-1990’s. She would like to see the Nursing group and the ERAS website used more as helpful resources for nurses: “The website should be used as a place for inspiration – examples of nursing care plans/ diaries and of course, the patient perspective. I love that the Patient Voice videos are on there! We should get some more stories from patients and their families. After all – we all want the same thing – better outcomes for our patients!” In the interim, it is with an even heavier heart (just kidding) that I have agreed to be interim chair of the ERAS Nursing Group. "My name is Angie Balfour and I have been an ERAS nurse for just a little while (since 1994) so I guess it’s only fair that the 2nd oldest ERAS nurse takes over this role!!" I have been the ERAS nurse in Edinburgh for several years working under the very watchful and supportive guidance of Prof Ken Fearon who sadly passed away at the beginning of September. The role of ERAS Nurse was very important to him and the fact that there are now lots of ERAS Nurses around the globe had made him and the other founding members of the ERAS Society very proud. With that in mind – it is my job to make sure we use this nursing group – to ask questions – to share experiences and lessons learned – to meet at congresses for G & T. My contact details are: angie.balfour@nhslothian.scot.nhs.uk 07896 293201 Thank you very much Dorthe for all you hard work over the years – it has been a tremendous honour and privilege to work with you. Angie Balfour. ### ERAS study day in Sydney, Australia, 2016 An intensive ERAS study day was held during the APAC Forum 2016, in Sydney, Australia on Monday 12th September 2016. With participation from several asian-pacific countries. ### ERAS USA launched The ERAS USA (erasusa.org) the ERAS Chapter for the USA of the ERAS Society was launched in Washington DC. ERAS USA will work alongside ERAS Society for the further development of ERAS in the USA and worldwide in a range of surgical disciplines, as well as running educational activities and ERAS implementation programs across the USA. Professor Tonia Young-Fadok, Mayo Clinic, Scottsdale is the first president of ERAS USA. ### Brazilian ERAS Implementation Program completed Two hospitals in Brazil just finished the 1st ERAS Society Implementation Program; The Albert Einstein Hospital in Sao Paolo and Santa Casa de Misericórdia de Porto Alegre. Both hospitals show excellent change management yielding good outcome results. The Training was performed under the regional leadership of Professor Adrian Alvarez, The Italian Hospital in Buenos Aires Vice President off ERAS Implementation for LATAM, alongside ERAS coach Valerie Addor from CHUV Lausanne with the assistance of Profs Olle Ljungqvist, Sweden and Nicolas Demartines, CHUV, Switzerland. ### Successful 1st Singapore ERAS symposia Tan Toc Seng Hospital hosted the 1st ERAS Society symposia in Singapore attracting more than 200 participants. The TTSH team has completed the ERAS Society Implementation Program with successful outcomes and is in the planning to start offering this training to other units in Singapore and the region. These results of this training also made headlines in the local press. For more information about upcoming actions in ERAS locally, please click here ### 2017 ERAS Alberta Symposium We’re pleased to announce the 2017 ERAS Alberta Symposium agenda, which is packed with local and international ERAS clinical experts. The ERAS Alberta 2017 Symposium is hosted by the Surgery Strategic Clinical Network, Alberta Health Services (AHS) to facilitate local, national and international Enhanced Recovery After Surgery (ERAS) best practices. Join your colleagues for stimulating discussions and presentations on Friday, January 27 and Saturday, January 28 for interactive discussions and high caliber presentations from leading international, national and local experts. To register, go to http://www.cvent.com/d/zvqw0d   ### Liver Surgery and Bariatric Surgery Guidelines now on ERAS Society website You can now access the full text articles for the ERAS Society guidelines for Liver and Bariatric Surgery via our website. ### New ERAS Society Head and Neck guidelines published The ERAS Society is proud to announce the publication of: Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society. You can read and/or download the guidelines here You can read and/or download a commentary here   ### Professor Ken Fearon It is with great sadness that the ERAS Society announce the sudden and tragic death of Professor Ken Fearon, Co-founder and Chairman of the ERAS Society Board.   He was an inspiration to us all: a brilliant academic, teacher and lecturer but above all a warm, generous and kind man. We will miss him sorely, and we send our deepest condolences to his family. Please click here to read and/or download an obituary written by Professor Olle Ljungqvist and Professor Dileep Lobo to be published in the journal Clinical Nutrition. ### Finalisation of the ERAS Implementation Program in Charlotte, North Carolina, USA The final seminar of the ERAS implementation program was held on 13th July 2016, at CMC in Charlotte NC. After eight months of intensive work, the team of Prof. Iannitti under the supervision of Dr. Vrochides was certified as ERAS Center of Excellence. The quality of the work performed during this implementation was outstanding and announces a very fruitful scientific and human collaboration, and will allow further implementation of ERAS in the United States of America.   The people in the picture are (from left to right): Dr. Dionisis Vrochides, MD PhD, ERAS leader Garth McClune, Nurse Manager Prof. Nicolas Demartines, CHUV-Lausanne-Switzerland Mrs Kendra Tezber, Clinical Nurse Valérie Addor, ERAS Coach, CHUV-Lausanne-Switzerland Cesar Aviles, Nurse Practitioner Specialist Mrs Allyson Cochran, MSPH, Clinical Research Data Manager ### The Philippines - 1st National ERAS Congress On September 8, 2016, The Medical City (TMC) hosted the country’s 1st National ERAS Congress at the Augusto M. Barcelon Auditorium, Pasig, Metro Manila.  Conducted by the ERAS Team of the hospital and supervised by the ERAS Society, the congress was a huge success with more than 400 delegates attending. Attendees were a mix of surgeons, anaesthetists, nurses, dietitians, and other healthcare professionals, including hospital administrators, from all over the archipelago, many with the intention of possibly implementing ERAS in their respective institutions. The Congress boasted an excellent faculty headed by Prof. Olle Ljungqvist of Sweden, and speakers representing the only two ERAS Centres of Excellence in Asia – The Medical City in Manila and Tan Tock Seng Hospital in Singapore. Key management and quality assurance leaders of TMC were included in the programme, and also participating in the Congress were partners in industry with interest in ERAS who gave significant support for the TMC ERAS Team’s endeavors to educate and train other hospitals in the ERAS pathway.  These companies were carefully selected by Congress organizers as being in line with the principles and protocols of ERAS, particularly with their products. ### Save the date! 5th ERAS World Congress, 10-12 May 2017, Lyon, France Save the date for the 5th ERAS World Congress, to be held 10-12 May 2017 in Lyon, France. We look forward to seeing you there! ### Free ERAS in Gynaecology Webinar To access a free ERAS in Gynaecological Oncology webinar on the topic of Post Surgical Pain Management Techniques for Enhanced Recovery click here. The webinar is presented by Professor Sean Dowdy and Professor Pedro Ramirez.   ### New ERAS® Society Website Welcome, whether you are a patient or work in healthcare! We are delighted to present our new website and hope that you like the updated design. We are very grateful to Javier Fabra from the University of Zaragoza, Spain for his excellent work as webmaster for the last five years and to introduce John Melkvist and his team as our new webmasters. We are also very pleased to welcome Tom Wainwright, Bournemouth, UK to our website editorial team. Tom brings a wealth of expertise to this role. The new website may take a few weeks to be completed fully, as we continue to migrate from our old site to our new site. Whilst we have updated a lot of the existing links, we have numerous additions to the existing website including closer links to overseas websites and social media. ERAS is growing rapidly around the world, with over a hundred units in over twenty different countries, with our recent Congress in Lisbon a huge success. We would very much like feedback and ideas from you to enhance both the content, appearance and the overall experience of the website. Please let me know! Dr Bill Fawcett editor@erassociety.org ### The 4th ERAS® World Congress The 4th ERAS® World Congress was held between 27th-30th April 2016, at the Lisbon Marriot Hotel, Portugal and was arguably the most successful to date. As in previous years, it consisted of the ERAS® Course followed by the Scientific Programme. Throughout the Congress, there were many high class and thought-provoking lectures from experts from around the World including North America, Latin America, Australia and South Africa and Europe. There were nearly 400 registrations for the Congress, with 2/3 of the delegates attending from European Continent, nearly 15% from North America, but with significant numbers too from Asia (8%), South America (5%), Oceania (3%) and Middle East (2%). On a country by country basis, our hosts Portugal provided the most delegates (58) but closely followed by the UK, US, Sweden and Switzerland. The next countries in order of delegates registered were Spain, Italy, Norway, France and Brazil. The ERAS® course was again a popular event, with the delegates learning about the relevant physiology underpinning the concepts of ERAS, viewed from many perspectives – surgeon, anaesthesiologist, nurse, manager and of course, the patient. There was a step by step approach to implementation of ERAS process and the evidence behind the many elements of care that make up modern ERAS process, including not only the immediate perioperative steps, but also the importance of preoperative patient education and postoperative audit and quality maintenance. The Scientific Programme some outstanding individual lectures. Of particular note, the prestigious Henrik Kehlet Lecture was given by Professor Rinaldo Bellomo from The University of Melbourne, Australia on “Postoperative urinary output”, and The ERAS Society Lecture was delivered by Professor Paul Greenhaff, from the University of Nottingham, UK on “Immobilisation and muscle function”. Both lectures were superb insights into fundamental physiology and pathophysiology. There was a popular parallel session on urology and the Delphi process for implementation of guidelines. There was also a session devoted to entirely to Nursing Practice. In addition, new technology and the measurement of the outcomes to which all in ERAS strive (patients, doctors and other healthcare providers and the healthcare purchaser) was debated. The importance of continual challenges of dogma was examined, as was the management of more complicated situations within ERAS, such as diabetes, the elderly and the emergency patient. It is always interesting to return to original research and have papers presented that changed the practice of the experts, as well as how this research is translated into outcome. It was a sign of the worldwide spread of ERAS that there were sessions on newer speciality areas, such as gynaecology, head and neck, breast reconstruction and liver surgery. The presentation of new and original work and ideas is always a very exciting and thought-provoking area of the ERAS® Congress. Both the oral and poster presentations were again very popular and remind us that whilst ERAS is well established, there are many areas from which we are still learning and that require detailed study and analysis. There were many excellent presentations, with the prize wining oral presentation won by Professor Tom Wainwright (UK) for his team’s work in knee and hip replacements, entitled “How long before routine next-day discharge for primary hip and knee replacement patients in the United Kingdom”. The huge success of the Congress is made possible only by the hard work of the Organising Committee and the Local Committee, to whom we express our sincere gratitude. In addition, we are most grateful to the sponsorship we receive from industry and the expert assistance from MCI. The 5th ERAS® World Congress for 2017 is already being planned and we look forward to welcoming you there! Further information will follow over the next month. ### ERAS Society Gynecology Guidelines featured at the 47th Annual Meeting on Women’s Cancer held in San Diego, USA. The recently published ERAS Society Gynecology Guidelines were given high level exposure at the 47th Annual Meeting on Women’s Cancer held in San Diego, California, USA March 18-22. The guidelines were highlighted in the Farr Nezhat Surgical Innovation Session. Professor Olle Ljungqvist presented on the history and development of Enhanced Recovery in the Farr Nezhat Plenary lecture. This was followed by presentation of the Guidelines by first author Dr Gregg Nelson of Univ Calgary, Alberta, Canada. Dr Sean Dowdy, Senior author of the Guidelines, presented his experience introducing ERAS at the Mayo Clinic, Rochester, Minnesota. Dr Dowdy co-chaired the session along with Dr Pedro Ramirez from MD Anderson, Houston Texas, who also played a key role in the Guideline work. Three young investigators presented their work related to ERAS to close the session: Drs. LA Meyer, MD Anderson; J N Bakkum-Gamez, Mayo Clinic; and SC Modesitt, Univ Virginia. The next step underway is the formation of a Gynecology Chapter within the ERAS Society – more to come about this shortly. ### April 2016 update Welcome to our April 2016 update on the ERAS Society Website! This month we bring to you two interviews with Tom Wainwright (Physiotherapist and Associate Professor in Orthopaedics at Bournemoth University, UK) and Yannick Cerantola (Consultant Urologist at Lausanne Switzerland). Interview with Tom Wainwright   https://vimeo.com/163513393 Interview with Yannick Cerantola   https://vimeo.com/152883988 We hope you all enjoy this fresh update! Also, remember that you can follow us on the Twitter Official Channel to stay up to date with what's happening in the ERAS field!     ### ERAS Implementation Program in Connecticut USA The ERAS Implementation Program in Connecticut USA held the third work shop was just held in Hartford and the teams are seeing marked improvements in outcomes already in their first patients. The program is plan to finish in July. Prof Franco Carli from McGill in Montreal, Canada was a special guest discussing and presenting special issue related to anaesthesia. The pictures show the participants and faculty outside St Francis hospital in Hartford, CT.                 ### March 2016 update Welcome to our March 2016 update on the ERAS Society Website! This month we are delighted to share with you two interviews with Professor Mustapha Adam (Professor of Surgery in Lyon, France) and Mr Nader Francis (Consultant Surgeon in Yoevil, UK). Interview with Professor Mustapha Adam   https://vimeo.com/152877456 Interview with Mr Nader Francis https://vimeo.com/152883986 In addition, we also have three new abstracts: Adherence to the ERAS-protocol and 5-year survival after colorectal cancer surgery: A retrospective cohort study, by Henrik Oppelstrup, Olle Ljungqvist, Anders Thorell, Jonas Nygren and Ulf. O. Gustafsson. [Read it here] Comparison of patient reported symptom burden pre- and post- implementation of an Enhanced Recovery Pathway for Gynecologic Surgery, by Larissa A. Meyer, Alpa M. Nick, Maria D. Iniesta, Qiuling Shi, LaKisha Washington, Melinda Harris, Lindsey D. Palmer, Katherine E. Cain, Terri W. Earles, Javier Lasala, Xin S. Wang and Pedro T. Ramirez. [Read it here] Adherence to the Enhanced recovery after surgery protocol and its economic impact. [Read it here] We hope you all enjoy this fresh update! Also, remember that you can follow us on the Twitter Official Channel to stay updated with what's happening in the ERAS field!   ### Success of Parts I and II of the Guidelines for postoperative care in gynecologic/oncology surgery We are delighted to announce that huge success of Parts I and II of the Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Part I is the most downloaded article in Gynecologic Oncology in the last 90 days with Part II the third most downloaded article. First author, Gregg Nelson, ERAS Lead, Assistant Professor and Tumour Group Leader at Tom Baker Cancer Centre, Calgary, writes: The ERAS Gynecologic/Oncology Guidelines are extremely important for the advancement of surgical care for both major gynecology and gynecologic oncology. Previous reviews of enhanced recovery protocols in our specialty demonstrated marked dissimilarities among practice patterns – this highlighted the need to develop formalized, evidence-based guidelines. Linking these guidelines with the ERAS Interactive Audit System (EIAS) is underway and will be crucial in order to allow for audit of compliance which has proven to be a key factor required for the success and sustainability of such protocols. We are hopeful that these ERAS guidelines will help integrate existing knowledge into practice, align perioperative care, and encourage future investigations to address existing knowledge gaps. ### February 2016 update Welcome to our February 2016 update on the ERAS Society Website! This month we want to share with all of you two experiences to date of implementing ERAS and their visions for the future with Hans De Boer (Anesthesiologist from Groningen, Holland) and Maciej Matlock (Surgeon from Warsaw, Poland). Interview with Hans De Boer https://vimeo.com/152877454 Interview with Maciej Matlock https://vimeo.com/152877455 Hope you all enjoy this fresh update! Also, remember that you can follow us on the Twitter Official Channel to stay updated with what's happening in the ERAS field! ### First ERAS® Society symposia in Argentina First ERAS® Society symposia in Argentina and the initiation of the first ERAS® Implementation Program in Latin America. Hosted by Prof Adrián Álvarez, the Italian Hospital Buenos Aires and the ERAS® Society. ### ERAS Alberta Symposium 2016 The ERAS Alberta Symposium was held in Calgary on January 15 & 16, 2016 to collaborate, exchange ideas and advance your knowledge in Enhanced Recovery After Surgery (ERAS) practices and researchers. Presenters included Dr. Henrik Kehlet, Dr. Olle Ljungqvist, Dr. Gabriele Baldini, Dr. Duane Funk and local ERAS champions including Dr. Don Buie, Dr. John Heine (TEMS), Dr. Joseph Dort and Dr. Claire Temple-Oberle. Topics presented included findings on patient experience and elderly friendly approaches to the surgical environment. Get more info here. ### January 2016 update Welcome to our January 2016 update on the ERAS Society Website! This month we want to share with all of you the following: The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties. Nicolò Pecorelli, MD, Julio F Fiore Jr., PhD, Chelsia Gillis, RD, Rashami Awasthi, BSc Benjamin Mappin-Kasirer, Petru Niculiseanu, MD, Gerald M Fried, MD, Francesco Carli, MD, Liane S Feldman, MD. [Read it here] The use of artificial neural networks to predict delayed discharge and readmission in enhanced recovery following laparoscopic colorectal cancer surgery.N. K. Francis, A. Luther, E. Salib, L. Allanby, D. Messenger, A. S. Allison, N. J. Smart, J. B. Ockrim. [Read it here] Also, remember that you can follow us on the Twitter Official Channel to stay up to date with what’s happening in the ERAS field! ### Mayo Clinic: Optimal Surgical Recovery Requires Teamwork The Enhanced Recovery After Surgery, Optimal Surgical Recovery Requires Teamwork will be held on the Point Hilton Tapatio Cliffs Resort, Phoenix, Arizona, on February 12-13 of 2016. Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, multi-modal approach to perioperative care. Evidence-based data is employed to optimize the patient’s post-op recovery promoting early recovery while post-op complications and costs are reduced. This proactive approach is comprised of data-driven, well thought-out interventions: “Post-op recovery starts in pre-op.” Starting with clearly defined preoperative preparation that involves the spectrum of health care team members, including the patient. Intraoperative approaches that have the entire scope of the patient’s care in mind including post-op recovery – multimodality pain control, pre-emption of nausea, and fluid management to minimize post-op ileus. Post-op order sets and team care that optimize patient recovery, convey the experience of accumulated knowledge and minimize complications and hospital stay. We will provide evidence-based best practices from foremost international leaders. Discussion panels will allow attendees to pick the brains of teams who have successfully improved their patients’ outcomes, and then return to their institutions with a plan For more information, please check the General Information & Program document, or visit their Website at this link. ### 1st National ERAS Society Argentina symposia The first national ERAS Society Symposia was held November 14 in Buenos Aires at the Italian Hospital, the first ERAS Society Center of Excellence in Argentina. The event was hosted by Professor Adrián Alvarez with speakers from his own department and with guest speakers RN ERAS specialist nurse Valerie Addor and professor Nicolas Demartines from CHUV Lausanne, Switzerland and professor Olle Ljungqvist Örebro, Sweden. The hall was filled to the rim with approximately 100 delegates not only from key centers in Argentina but also with key opinion leaders from Chile, Uruguay and Peru. During this event the principles of ERAS were presented alongside the work of the ERAS Society. The interest was extremely high and several teams have already shown their interest in implementing ERAS. This event was the starting point of the building of the ERAS Society network in Latin America. For more information please contact professor Alvarez:tatotatun@gmail.com. The organizer acknowledge the unrestricted educational support from MSD. ### 1st ERAS Society Implementation Program in Latin America The first ERAS Society Implementation program was started in Buenos Aires, Argentina November 15-16. The program was hosted by the Italian Hospital under the leadership of professor Adrián Álvarez and his team. Two leading teams from other Latin American countries were in the program aiming to produce a lead team for each country for the implementation of ERAS. One team from Bogota, Colombia; Clinica Reina Sofia Org Sanitas and one from Guadalajara Mexico: Hospital Civil de Guadalajara were trained. The team consisted of surgeons and anesthesia leads, a dedicated ERAS nurse, and other specialists including representation from the senior management. The ERAS Implementation program will be turn over period of about 8 months. The first session was run with the support of guest speakers, teachers and coaches RN ERAS specialist nurse Valerie Addor and professor Nicolas Demartines from CHUV Lausanne, Switzerland and professor Olle Ljungqvist Örebro, Sweden.     ### A new way to bounce back after surgery Check the out the article entitled ”A new way to bounce back after surgery" and published on the American Association of Retired Persons (AARP) Bulletin in the July-August issue.     Access directly the article following this link: http://pubs.aarp.org/aarpbulletin/20150708   ### October 2015 update On this first month of periodic updates on the ERAS Society Website, we want to share with all of you the following: A prize winning abstract from the 2015 Washington Congress: Adherence to the ERAS-protocol and 5-year survival after colorectal cancer surgery: A retrospective cohort study, by Henrik Oppelstrup, Olle Ljungqvist, Anders Thorell, Jonas Nygren, Ulf. O. Gustafsson. [Read it here] An outstanding video interview with Professor Henrik Kehlet recorded during the Guildford UK Improving Perioperative Outcomes Meeting. [Watch it here] A report of the Optimising outcomes in Gastrointestinal Surgery meeting held on 5-6 October, 2015 at MATTU Guildford. [Read it here] Hope you all enjoy this fresh update! Also, remember that you can follow us on the Twitter Official Channel to stay updated with what's happening in the ERAS field! ### The SAGES/ERAS Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery The SAGES/ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery Editors: Feldman, L.S., Delaney, C.P., Ljungqvist, O., Carli, F. (Eds.)   Presents a comprehensive, up to date and practical approach to creating an ERAS program for GI surgery Written by experts in the field, including surgeons, anesthesiologists, nurses, and physiotherapists Experts contribute real-world examples of their pathways for a variety of procedures, enabling the user to have a starting point for creating their own programs   This volume presents a comprehensive, up to date and practical approach to creating an ERAS program for GI surgery. The first sections review the evidence underlying individual elements of ERAS, including evidence from laparoscopic procedures when available or pointing to evidence gaps where more research is required. These are written by experts in the field, including surgeons, anesthesiologists, nurses, and physiotherapists. The format is in the style of a narrative review, with narrative evidence review, and concluding with a table with “take home messages” and 3-5 key references for readers interested in more depth in each topic. Each chapter also addresses management of common complications and patient selection or exceptions. Subsequent chapters address practical concerns, including creation of a pathway team, project management and engaging administration. Experts contribute real-world examples of their pathways for a variety of procedures, including colorectal surgery, bariatric surgery, upper GI and hepatobiliary surgery, enabling the user to have a starting point for creating their own programs. The SAGES Manual of Enhanced Recovery Programs for Gastrointestinal Surgery will be of great value to fully trained surgeons, anesthesiologists, nurses and administrators interested in initiating an ERAS program. Check it out and order on both printed and electronic formats at Springer site: http://www.springer.com/us/book/9783319203638 ### ERAS Society activities in the USA The ERAS® Society has growing activities in the USA. Following the 3rd World Congress for the ERAS® Society in Washington DC in May of this year, we are now happy to announce the first ERAS® Society Implementation program just started in collaboration with the CtSQC in the state of Connecticut. The first of a series of ERAS Implementation program involves four hospitals in Connecticut: St Francis Hospital, Norwalk Hospital, Lawrence & Memorial hospital and Middlesex hospital. The implementation program will continue in a few phases where most of the hospitals involved in major surgery will be trained using the ERAS® Society Implementation program. For questions about the developments in the USA and interest in the ERAS® Society Implementation program, please contact Kristina Wikander at the ERAS® Society office: kristina.wikander@erassociety.org For questions about the program in Connecticut please contact Cynthia Ross-Richardson: Cynthia.Ross-Richardson@hhchealth.org The leaders for the CtSQC Collaborative - ERAS® Society Implementation program, from left to right: Robert Lincer, MD, FACS, Local initiator of the ERAS Implementation program, Angie Balfour, RN University of Edinburgh, UK, ERAS Society Implementation coach for the program, Berson Augustin, McGill University Hospital, Montreal Canada, ERAS Implementation coach, Cynthia Ross-Richardson,RN, CT ERAS® Coordinator, Scott Ellner, DO, FACS Program Chairman of the CtSQC, Kathleen Gravelle, RN – CtSQC ERAS Educator, Dr Olle Ljungqvist, Örebro University & Karolinska Insititutet, Sweden, ERAS® MD trainer. Phase 1 hospital teams involved in the ERAS® Implementation Program in Connecticut, USA July 16, 2015. The teams in full training during the first day of the ERAS Implementation program. ## Pages ### Communication preferences [automatewoo_communication_preferences] ### Content restricted [wcm_content_restricted] ### My account ### Checkout ### Basket ### Shop ### Events ### Centres of Excellence ### Past Events ### Thank you A member of the ERAS® Society will contact you shortly to progress your membership application ### Join the ERAS® Society Name Job title Organisation Mobile phone Field of Interest Billing Purchase Order Number Billing name Country Select country Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (Democratic Republic) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (Democratic People's Republic of) Korea (Republic of) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Billing address street Billing address line 2 City State Select state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawai Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Postal code E-mail address Cardholder’s name Card info I accept the Terms of Use Subscribe Payment details           Total     ### Patient Info What is ERAS®? ERAS® is short for Enhanced Recovery After Surgery. ERAS® is a treatment program based on the best available medical science. The ERAS® Society is a not for profit medical society with international experts in surgery, anaesthesia, nursing, and all other health care professionals working bedside with patients. The society publishes and updates the guidelines for best care for a series of surgical operations. Why use ERAS®? Numerous research reports have shown that employing ERAS® as opposed to traditional care has marked effects on recovery. In many surgeries recovery time can be shortened by 30% or more and complication rates after the operation by at least as much. Who does ERAS®? Click here to see where your nearest hospital that has been trained by the ERAS® Society. Click here to find the national ERAS@ Society lead centre in your country. What does ERAS® look like for the patient? If you click here to look at patient information brochures that explain what happens to a patient undergoing an operation under ERAS® care. What makes ERAS® work so well? The protocol items is developed and run by a team of the key professionals involved; surgeons, anaesthetist, nurses, dieticians, Physiotherapists and others and they jointly keep control over the entire patient journey and audit the treatment continuously. Patient's experience of ERAS® If you use any of the below films in presentations please be sure to credit the ERAS® Society and also the following statement "Thank you to June, Connie and Tony for sharing your experience. Filmed by Stephen Punton, Stephen Preston and Annette Frederiksen. Edited and Produced by Racoon Film". https://www.youtube.com/watch?v=igpen49GlCw https://www.youtube.com/watch?v=ONXSAZ9v9ZY https://www.youtube.com/watch?v=EoF4Dl8uJ-o ### Chinese 中文 History 历史 Executive Committee 执行委员会 Associated Websites 相关网站 ### Specialties ### Registration [mepr-membership-registration-form id="21789"] ### Subscriptions Manage your account Enter the e-mail address used for your purchase(s). You are going to receive a security code to your e-mail address. Get security code ### Membership A member of the Memberships team will be in touch with you shortly ### Terms & Conditions Copyright© ERASSociety.org® - Disclaimer Compliance with laws and regulations ERASSociety.org is an academic and research project developed by the ERAS® Society and it is compliant with Swedish and international laws. All users browsing the ERASSociety.org site should agree with the terms and conditions listed in this disclaimer. Article 8 of the Charter of Fundamental Rights of the European Union expressly recognises the fundamental right to the protection of personal data. Therefore, the suscription to the ERASSociety.org academic project will be directed under the following terms and conditions. All personal data provided during the registration process only will be used to send the ERASSociety.org newsletter and information related to online courses and the ERASSociety.org Website. No data will be transferred to third-parties, keeping all the information private. Applicable copyright and industrial property regulations in multimedia creations, software, texts, articles, photos, registered trademarks, databases, and images of all kinds. The name and domain ERASSociety.org and associated domains have been registered under Swedish law and according to the ICANN rules for domains. Any use of these domain names or links to the content shown in their pages should be authorized previously by means of a written agreement with the ERASSociety.org, which can be obtained contacting us at info@erassociety.org. Articles Intellectual property regulations subject to the provisions of article L. 122- 5. 2 and 3 a) of the European International Law for Intellectual Property only allow copies or reproductions that are strictly reserved for private use but not intended for collective use and analyses and short citations used as examples and illustrations, and state that any total or partial reproduction without prior authorization of the author and associates constitutes infringement (article L. 122-4). Such representation or reproduction by any means whatsoever would constitute an infringement of articles L. 335-2 and those that follow within the intellectual property regulations. Advertising Policy and Partner Websites Our website provides links towards partner’s Websites. Please note that we do not control the contents published on these partner’s Websites. Our Editorial and Scientific Editing and Steering Committee remains absolutely free, unbiased and independent of any marketing or advertising influence. Multimedia Content Pictures and videos Pictures and videos showing individuals are used only for the purposes of illustration. In any video commentaries and documents published on ERASSociety.org , no data related to patient’s information is provided. In this sense, no personal information can be exposed when writing comments When you take part in forums and chats, please do not use any such identifying information when you discuss a case. ERASSociety.org, and in certain cases its partners, are the holders of all intellectual or industrial property rights pertaining to the content of ERASSociety.org. In particular, the illustrations are originals and the videos have been recorded specifically for use on ERASSociety.org. Some slides and content has been taken from public educational sites. In these cases, the source URL is provided if available. If you use any information on ERASSociety.org , you are required to obtain our prior written authorization before any distribution thereof. For such purpose, you are reminded that any indications pertaining to the existence of rights may not be deleted, and that any total or partial reproduction without authorization constitutes infringement. In addition, you are prohibited from any substantial qualitative or quantitative extraction of ERASSociety.org databases, or from using the databases in an abnormal context. Regulations on the automated processing of personal data Public policy regulations, such as those pertaining to any pornographic, racist or unlawful content that may be harmful to another Internet user or may undermine the brand image of ERASSociety.org, by means of provocative messages, texts or images. Regulations pertaining to the privacy of individuals, whether Internet users connected to ERASSociety.org or third parties On such basis you undertake not to send, via the interactive services offered to you, any messages of an insulting, offensive, denigrating or degrading nature or messages that are unrelated to the issues raised. Regulations pertaining to the rights of the press On such basis you shall refrain from any defamation or insults against online Internet users or third parties. Regulations pertaining to computer fraud On such basis you shall refrain from any hacking of an automated data processing system or from any partial or total alteration of the elements therein. You are hereby informed that anyone committing such acts may be prosecuted. More specifically, in the context of the interactive services, ERASSociety.org reserves the right to delete content of any kind whatsoever, immediately and without prior notice, and especially any message, photograph or graphics that may violate applicable laws and regulations and especially those regulations mentioned hereinabove.   Information about the ERAS® Trademark ERAS® stands for Enhanced Recovery After Surgery and is used for a process of perioperative care. The ERAS® Society is a non for profit medical society active in all parts of the world. The ERAS® Society has gathered world expertize to produce, publish and update Guidelines for evidence based perioperative care for a growing number of surgeries in different surgical disciplines. These Guidelines forms the basis for training programs helping units worldwide to implement the ERAS® Society guidelines, the ERAS® Implementation Programs. As part of these programs an interactive IT system is used, the ERAS® Interactive Audit System. The ERAS® Society holds the exclusive Trademark rights for the word ERAS® and for the logos and for computer programs, education and instruction services, education and instruction material, scientific and technological services, medical research services, and design and development of computer hardware and software. For these services we guarantee the quality and for units trained in these programs and using our systems we give the ERAS® Society certification/diploma that are updated on a regular basis. The ERAS® Society and its partners happy to help any organisation to implement ERAS® by offering our services via Encare AB (www.erassociety.org) Any use of the word of ERAS® must be accompanied by the Registered Trademark symbol ®. As such the wordmark ERAS® can be used. Anyone using the word ERAS® does not mean that the ERAS® Society approved these programs, systems, materials or events. Only direct collaborations with the ERAS® Society or its national affiliates or partners may use the ERAS® Trademark along with the ERAS® Society logo for any systems or events and the use of the Logo alongside ERAS® serves as the sign of full approval by the ERAS® Society. Full PDF detailing Information about the ERAS® Trademark available here © June 2016 ERAS® Society ### Partners & Supporters ### Centres of Excellence An ERAS® Society appointed Centre of Excellence is a centre that has completed an ERAS® implementation program and has qualified as a teaching centre for the implementation program, and/or has made considerable contributions to the development of ERAS® for the ERAS® Society. To contact any of the Centres of Excellence please click here  ### History  The mission of the ERAS® Society is to develop perioperative care and to improve recovery through research, education, audit and implementation of evidence-based practice. The mission of the Society is to develop peri-operative care and to improve recovery through research, education, audit and implementation of evidence-based practice. Below is short description of how the ERAS®Society was developed and some highlights from its history. ### Expert Reviews On this page you'll find expert reviews on newly published peer-reviewed publications related to the field of ERAS®. The expert reviewer will summarise what is already known on the subject and what the paper adds. General ERAS Bariatric Colorectal Liver Nursing and AHPs Pancreas Pre-operative Preparation Thoracic Upper Gastrointestinal Urology ### Publications © 2020 Enhanced Recovery After Surgery A Complete Guide to Optimizing Outcomes Editors: Ljungqvist, Olle, Francis, Nader, Urman, Richard D. (Eds.) This book is the first comprehensive, authoritative reference that provides a broad and comprehensive overview of Enhanced Recovery After Surgery (ERAS®). Written by experts in the field, chapters analyze elements of care that are both generic and specific to various surgeries. It covers the patient journey through such a program, commencing with optimization of the patient’s condition, patient education, and conditioning of their expectations. Organized into nine parts, this book discusses metabolic responses to surgery, anaesthetic contributions, and optimal fluid management after surgery. Chapters are supplemented with examples of ERAS® pathways and practical tips on post-operative pain control, feeding, mobilization, and criteria for discharge. Enhanced Recovery After Surgery: A Complete Guide to Optimizing Outcomes is an indispensable manual that thoroughly explores common post-operative barriers and challenges. Order your copy here World Journal of Surgery Official Journal of the International Society of Surgery/Société Internationale de Chirurgie Editors: Julie A. Sosa World Journal of Surgery is the official publication of the International Society of Surgery/Societe Internationale de Chirurgie (iss-sic.com). Under the editorship of Dr. Julie Ann Sosa, World Journal of Surgery provides an in-depth, international forum for the most authoritative information on major clinical problems in the fields of clinical and experimental surgery, surgical education, and socioeconomic aspects of surgical care. Contributions are reviewed and selected by a group of distinguished surgeons from across the world who make up the Editorial Board. Order your copy here   The SAGES/ERAS® Society Manual of Enhanced Recovery Programs for Gastrointestinal Surgery Editors: Feldman, L.S., Delaney, C.P., Ljungqvist, O., Carli, F. (Eds.) This volume presents a comprehensive, up to date and practical approach to creating an ERAS® program for GI surgery. The first sections review the evidence underlying individual elements of ERAS®, including evidence from laparoscopic procedures when available or pointing to evidence gaps where more research is required. These are written by experts in the field, including surgeons, anesthesiologists, nurses, and physiotherapists. The format is in the style of a narrative review, with narrative evidence review, and concluding with a table with “take home messages” and 3-5 key references for readers interested in more depth in each topic. Each chapter also addresses management of common complications and patient selection or exceptions. Subsequent chapters address practical concerns, including creation of a pathway team, project management and engaging administration. Experts contribute real-world examples of their pathways for a variety of procedures, including colorectal surgery, bariatric surgery, upper GI and hepatobiliary surgery, enabling the user to have a starting point for creating their own programs. The SAGES Manual of Enhanced Recovery Programs for Gastrointestinal Surgery will be of great value to fully trained surgeons, anesthesiologists, nurses and administrators interested in initiating an ERAS® program. Check it out and order on both printed and electronic formats at Springer  Basic Concepts of Fluid and Electrolyte Therapy Dileep N. Lobo, Andrew J. P. Lewington, Simon P. Allison This book, ‘Basic Concepts of Fluid and Electrolyte Therapy’, fills a long felt need for an up to date pocket guide to the subject. Water and electrolyte balance is crucial for body homeostasis and is one of the most protected physiological mechanisms in the body. While we can survive for months without food, without water intake we die very quickly. Similarly the body has very strong mechanisms to control salt and water balance, an understanding of which has major implications in clinical practice. Despite salt and water balance being so fundamental for homeostatic control, knowledge and practice of fluid and electrolyte therapy has been shown to be appallingly poor among many health care professionals. The results of such knowledge surveys have been reported by the authors and were surely the reason why they felt the urge to write this book. Dileep Lobo, Andrew Lewington and Simon Allison are all well renowned experts in this field covering different aspects of the topic: surgery, renal medicine and clinical nutrition. This allows for a broad approach to the concepts of fluid and electrolyte management and gives the book sufficient depth to fulfil the basic needs of all medical specialties. The book covers the basics in physiology and pathophysiology, how to assess fluid and electrolyte status, a clear overview of fluids used in clinical practice and how to prescribe them, and then moves on to describe and discuss some of the most common clinical problems. The book is rich in tables and figures that help the reader grasp the fundamentals, both physiological and pathophysiological. It contains examples of how to address clinical situations and to monitor treatment, often with the help of simple cartoons and figures. The authors have also done a fine job in explaining some of the more complex issues involved, making this book a very useful read for everyone involved in patient care, as well as for students in training for any higher qualifications in the medical professions. Whether you are a professional in medicine or a student, enjoy this very interesting read, and make use of it in your practice! Download your free PDF copy here Basic_Concepts_of_Fluid_and_Electrolyte_Therapy Basic Concepts of Fluid and Electrolyte Therapy - 2nd Edition Dileep N. Lobo, Andrew J. P. Lewington, Simon P. Allison The first edition of this book was published in 2013 with the aim of improving understanding and clinical practice in the field of fluid and electrolyte therapy. Studies at that time suggested that, even though fluid and electrolyte preparations are the most commonly prescribed medications in hospitals, management of fluid and electrolyte disorders was suboptimal, possibly due to inadequate teaching, causing avoidable morbidity and even mortality. It should not be forgotten that fluid therapy, like other forms of treatment, has the capacity to do harm as well as good unless administered with care and based on sound knowledge. Given advances in knowledge and practice over the last nine years since the first edition the authors felt a second edition was required. As well as updating previous chapters, they have added new chapters on Ageing and Fluid Balance, Chronic Kidney Disease, Fluid Overload and the De-escalation Phase, and Perioperative Fluid Therapy and Outcomes. The authors really are experts in their field and have produced a fantastic and comprehensive guide to the complex world of fluid management. Download your free PDF copy here: Basic_Concepts_of_Fluid_and_Electrolyte_Therapy_2nd_Edition Manual of Fast Track Recovery for Colorectal Surgery Editor(s): Nader Francis, Yeovil District Hospital NHS Foundation, Yeovil, UK; Robin H. Kennedy, St Mark's Hospital, Harrow, UK; Olle Ljungqvist, Örebro University Hospital, Örebro, Sweden; Monty G. Mythen, University College London, London, UK The Manual of Fast Track Recovery for Colorectal Surgery provides a broad overview on enhanced recovery, with expert opinions from leaders in the field regarding elements of enhanced recovery care that are generic and specific to colorectal surgery. This book covers the patient journey through such a programme, commencing with optimisation of the patient's condition, patient education and conditioning of their expectations. Manual of Fast Track Recovery for Colorectal Surgery investigates the metabolic response to surgery, anaesthetic contributions and optimal fluid management, after surgery. Manual of Fast Track Recovery for Colorectal Surgery is a valuable reference tool for colorectal surgeons, anaesthetists, ward nurses and other members of the team involved in perioperative care: pain control specialists, physiotherapists, dietitians, specialist therapists and outpatient nurses. Contents: Overview: Key Elements and the Impact of Enhanced Recovery Care.- Pre-Operative Optimisation and Conditioning of Expectations.- The Metabolic Stress Response and Enhanced Recovery.- Anaesthetic Contributions in Enhanced Recovery.- Peri-Operative Fluid Management in Enhanced Recovery.- Pain Control After Surgery.- The Role of the Enhanced Recovery Facilitator.-Colorectal Surgery and Enhanced Recovery.- Setting up an Enhanced Recovery Programme.- Success and Failure in Colorectal Enhanced Recovery.- Data Collection and Audit. Order your copy here ### Policy on Guidelines ERAS® Society Policy on Guidelines Objective: To outline the policies of the Society in relation to guideline development. Background Guidelines produced by the ERAS® Society are an important and central mission for the Society. They should be evidence based, uniformly formatted and used as an important framework for clinical care of the surgical patient. Given the impact of previous guidelines, this constitutes a major responsibility placed upon the Society. Therefore, the ultimate decisions about the commissioning, publication and dissemination of the guidelines will rest with the Executive Committee. Topics for new guidelines are welcome and should be addressed initially to the Chair of the Scientific Committee. All suggested topics will be presented by the Scientific Chair and considered by the full Executive Committee. Guidelines Committee The Executive Committee will appoint a Guideline Committee (generally n= 2 or 3). The Guideline Committee will have at least one member from the Executive Committee and one from the Scientific Committee. The Guideline Committee will report to the Scientific Committee. In the absence of suggestions from members of the Society, the Guideline Committee will identify areas where guidelines are necessary (or need to be updated) and propose lead and senior authors. The Guideline Committee will be responsible for development of the format of guidelines, approval of the final version, decision to publish and journal of first choice. The Guideline Committee will appoint an Editor for each Guideline. Authors and collaborators Authors of guidelines should be experts in the field and should have published a reasonable body of original work in the area. The Executive Committee prior to start of the work should approve authorship. To maintain uniformity, interpretation of data should be done by senior clinicians/researchers. Responsibility for grading of evidence and recommendations should rest with the first and senior authors with input from the Guideline Committee. The target should be approximately eight to ten main authors (more when approved by Guideline Committee) plus, the Editor appointed by the Guideline Committee, followed by associates (if necessary – ERAS® working party on…………..). Associates can include junior staff, who have done systematic reviews etc. The Society strongly supports involvement of junior academic staff in guideline development. Literature reviews are highly welcome from junior staff. These can be published as separate, independent pieces of academic work. Guideline Editor(s) input There may be highly variable requirements but Editors should be an author, when appropriately involved in the project. Format of the guidelines The format of the guidelines should be decided by the Guideline Committee to ensure uniformity and proper development over time. [See format used by Gustafsson U et al Clinical Nutrition 2012, 31, 783-800]. Labour and Time lines Clear division of labour and timelines should be agreed among authors and the Guideline Committee, and if possible with the Publisher at the outset. Deadlines need to be clearly stated. The lead author should send regular (quarterly) updates by to the relevant Editor appointed by the Guideline Committee. Authors who do not meet deadlines will need to negotiate continuation on the guideline with the Guideline Committee. General principles for introduction of data collection for new practice guidelines New Guidelines should be followed by the introduction of a new area for that topic on the ERAS® Society Interactive Audit (EIAS) database. For existing EIAS systems already in use, the appropriate action will often be an update of the database to match the updated guidelines. A core team including the authors of the guidelines (preferably including the first and senior author) in collaboration with the database designers should develop this introduction or update. The ERAS® Society has a contract with ENCARE AB to provide an interactive audit system which should be used (ERAS® Interactive Audit System). Under the current agreement this is the official ERAS® Society audit system. Once the database is in place, the Guideline Committee will select a co-ordinator for groups of units to record, evaluate and publish consecutive patient series. This initial series then becomes the basis for further development and research in the domain of the guideline. Revision of Existing Guidelines All existing guidelines will be considered for revision by the Scientific and the Executive Committee every 3 years or earlier if appropriate. ### News ### FAQ ### Contact [vc_row row_type="row" use_row_as_full_screen_section="no" type="full_width" text_align="left" css_animation=""][vc_column][vc_empty_space height="64px"][/vc_column][/vc_row][vc_row row_type="row" use_row_as_full_screen_section="no" type="full_width" text_align="left" css_animation=""][vc_column width="2/6"][vc_column_text] Send us an e-mail [/vc_column_text][vc_empty_space height="20px"][contact-form-7 id="35" html_class="cf7_custom_style_1" title="Say hello"][/vc_column][vc_column width="1/6"][icons icon_pack="font_awesome" fa_icon="fa-map-marker" fa_size="fa-3x" type="normal" target="_self"][vc_empty_space height="20px"][vc_column_text] ERAS® Society Olof Palmes gata 29, 4th floor SE-111 22 Stockholm Sweden [/vc_column_text][/vc_column][vc_column width="1/6"][icons icon_pack="font_awesome" fa_icon="fa-twitter" fa_size="fa-3x" type="normal" target="_self"][vc_empty_space height="20px"][vc_column_text] Follow the conversation of perioperative care on our Twitter account. [/vc_column_text][/vc_column][vc_column width="1/6"][icons icon_pack="font_awesome" fa_icon="fa-facebook" fa_size="fa-3x" type="normal" target="_self"][vc_empty_space height="20px"][vc_column_text] Stay updated on how we enhance recovery after surgery on our Facebook page. [/vc_column_text][/vc_column][vc_column width="1/6"][icons icon_pack="font_awesome" fa_icon="fa-instagram" fa_size="fa-3x" type="normal" target="_self"][vc_empty_space height="20px"][vc_column_text] See pictures from our world @erassociety [/vc_column_text][/vc_column][/vc_row][vc_row row_type="row" use_row_as_full_screen_section="no" type="full_width" text_align="left" css_animation=""][vc_column][vc_empty_space height="100px"][/vc_column][/vc_row][vc_row row_type="row" use_row_as_full_screen_section="no" type="full_width" text_align="left" css_animation=""][vc_column][vc_gmaps link="#E-8_JTNDaWZyYW1lJTIwc3JjJTNEJTIyaHR0cHMlM0ElMkYlMkZ3d3cuZ29vZ2xlLmNvbSUyRm1hcHMlMkZlbWJlZCUzRnBiJTNEJTIxMW0xOCUyMTFtMTIlMjExbTMlMjExZDIwMzQuMTUyODY0MzIxNjI0JTIxMmQxOC4wMzc2Nzk0MTYwOTE1ODUlMjEzZDU5LjM0NzA5NjA4MTY2NTA3JTIxMm0zJTIxMWYwJTIxMmYwJTIxM2YwJTIxM20yJTIxMWkxMDI0JTIxMmk3NjglMjE0ZjEzLjElMjEzbTMlMjExbTIlMjExczB4NDY1ZjlkNzZiNzBlYWQ4MyUyNTNBMHhhNDNiYjcxODU1OWEyNGU4JTIxMnNTYW5rdCUyQkVyaWtzZ2F0YW4lMkIxMTclMjUyQyUyQjExMyUyQjQzJTJCU3RvY2tob2xtJTIxNWUwJTIxM20yJTIxMXNlbiUyMTJzc2UlMjE0djE0NjQxMjQ0OTkzODIlMjIlMjB3aWR0aCUzRCUyMjYwMCUyMiUyMGhlaWdodCUzRCUyMjQ1MCUyMiUyMGZyYW1lYm9yZGVyJTNEJTIyMCUyMiUyMHN0eWxlJTNEJTIyYm9yZGVyJTNBMCUyMiUyMGFsbG93ZnVsbHNjcmVlbiUzRSUzQyUyRmlmcmFtZSUzRQ==" size=""][/vc_column][/vc_row][vc_row row_type="row" use_row_as_full_screen_section="no" type="full_width" text_align="left" css_animation=""][vc_column][vc_empty_space][/vc_column][/vc_row] ### Patient Information What is ERAS? ERAS is short for Enhanced Recovery After Surgery. ERAS represents a new way of thinking about how we look after patients undergoing major surgery. It helps patients recover from their operation sooner, so that life can return to normal as quickly as possible. ERAS is a treatment program made up of a number of different elements based on the best available medical science. It also focuses on making sure you are actively involved in your recovery.  The main aspects are planning and preparation before admission (including improving your nutrition and physical fitness before surgery); reducing the physical stress of the operation; a structured approach to the management during your hospital stay (including pain relief and early nutrition); and getting you moving as soon as possible. The ERAS® Society is a not for profit medical society with international experts in surgery, anaesthesia, nursing, and all other health care professionals working bedside with patients. The society publishes and updates the guidelines for best care for a series of surgical operations. Why use ERAS? Numerous research reports have shown that employing ERAS as opposed to traditional care has marked effects on recovery. In many surgeries recovery time can be shortened by 30% or more and complication rates after the operation by at least as much. Who does ERAS? Click here to see where your nearest hospital that has been trained by the ERAS® Society. Click here to find the national ERAS@Society lead centre in your country. What does ERAS look like for the patient? If you click here to look at patient information brochures that explain what happens to a patient undergoing an operation under ERAS care. What makes ERAS work so well? The protocol items is developed and run by a team of the key professionals involved; surgeons, anaesthetist, nurses, dieticians, Physiotherapists and others and they jointly keep control over the entire patient journey and audit the treatment continuously. Patient's experience of ERAS Please see the films below to see how patients experienced an ERAS pathway in their own words. They are divided into what to expect before the operation, after the operation before they left hospital and finally what to expect after discharge. [If you use any of the below films in presentations please be sure to credit the ERAS® Society and also the following statement “Thank you to June, Connie and Tony for sharing your experience. Filmed by Stephen Punton, Stephen Preston and Annette Frederiksen. Edited and Produced by Racoon Film”.] https://www.youtube.com/watch?v=igpen49GlCw https://www.youtube.com/watch?v=ONXSAZ9v9ZY https://www.youtube.com/watch?v=EoF4Dl8uJ-o ### About ### Events ### Interactive Audit ERAS® Interactive Audit System A web based, on-line, interactive software tool to control compliance with the ERAS® Protocols (EBM - Evidence Based Medicine) supporting implementation, decision support and continuous quality control in a health care provider setting. Further, this allows the team to take advantage of the benefits of the ERAS® Protocol in terms of reduction in patient recovery time, reduction in the rate of complications, and improvement of the quality of care. By continuous follow up, analysis, adjustments and improvements, the perioperative team and its management can not only ensure improved patient outcome but also increase the understanding of the perioperative care process and thus the motivation of the staff involved. ### Implementation ERAS® Implementation Program ERAS® Implementation Program is an implementation and training program designed for perioperative care teams to implement, reach and maintain a high compliance level to the different ERAS® Protocols available. Much of the focus is on building well-functioning teams from various units involved in surgical care, introducing highly specific changes to current routines to conform to best practice, and providing the tools to monitor and analyze the effects of those changes, through ERAS® Interactive Audit System (EIAS). The ERAS® Implementation Program is based on teamwork in the perioperative process - nurses, anesthesiologists and surgeons. ERAS® Implementation - FAQs 1. What are the costs to implement the ERAS® program? Encare is the appointed enabler of the ERAS® Implementation Program (EIP), please contact Encare at info@encare.net or through their website for pricing details. All fees must be paid at least two weeks prior to the start of the first ERAS® Implementation Program seminar. 2. What are the conditions for becoming an ERAS® team? Participants to an ERAS® Team includes 5-7 people from the various units involved in perioperative care, including surgery, anesthesiology, intensive care, postoperative care, sponsor and possibly a representative from the quality control department of the institution. The following is an example of a well-balanced team: • Surgeon (Team leader) • Surgical Nurse (usually the ERAS® Coordinator, responsible for registration) • Anesthesiologist (may be also Team leader) • Anesthesia/high-dependency nurse • Sponsor (required) – this is the person who is financially responsible for the department. Could be department head or member of hospital’s executive board. This person orders and supports the process but does not take active part. • Representative from Hospital’s Quality Department (optional) • Dietician (optional) 3. How long does the training last? The training includes 4 seminars spread over a period of about 8-10 months. There is plenty of homework to do between the seminar, like put the 50 pre-ERAS patients as baseline, then start with the first ERAS® patients, etc. Please contact Encare at info@encare.net or through their website for further details about the ERAS® Implementation Program. 4. Is there a final exam? Provided the ERAS® team has fulfilled the ERAS® Implementation Program and its criteria, the department and each participating person will receive a certificate as an ERAS® Qualified Unit. 5. Is the certification renewed from year to year? As long as the ERAS® Qualified Unit continues to adhere to the ERAS® guidelines and show progress using the ERAS® Interactive System, the certificate will be renewed. ### Guidelines ### Associated Sites
& National Contacts ### Home ## Products ### Subscriptions Select your Membership All memberships run for twelve months from the day of purchase. ## People ### Dr Marianna Sioson (Philippines) Dr. Marianna Sioson is the Section Head of Medical Nutrition, Department of Medicine, The Medical City Hospital in Manila. She is a member of the nutrition support teams in various hospitals in her country. She is a family physician specializing in medical nutrition. She completed her 2-year fellowship in Nutrition Support in Manila and did observership both in South Carolina, USA, and in Brussels, Belgium. Dr. Nina is one of the frontrunners of ERAS in Asia. She was instrumental in establishing The Medical City Hospital as one of 2 ERAS Centers of Excellence in Asia. Aside from her position as nutrition champion for ERAS in her hospital, she is also currently Vice President of ERAS Philippines. She has also been active in developing guidelines and strategies for implementing ERAS in LMICs. Dr. Nina is faculty at The Medical City’s Medical Nutrition Fellowship, its Department of Family and Community Medicine, and the Ateneo School of Medicine and Public Health. She is a past president of the Philippine Society for Parenteral and Enteral Nutrition or PhilSPEN, and currently sits on the Philippine College of Medical Nutrition Physicians board. ### Dr Andrew Kermode ### Dr Shu-Lin Guo (Taiwan) Dr. Shu-Lin Guo is an established and highly skilled anesthesiologist with 20 years of experience in cardiothoracic anesthesia. He is well regarded in the Taiwan Society of Anesthesiologists (TSA), and Taiwan Society of Cardiothoracic and Vascular Anesthesia (TSCVA), earing numerous accolades for his fully dedication without reservation. He also received several outstanding awards in professional services and academic contributions. Dr. Guo believes physicians should always treat patient, not the disease. He chooses to practice the patient-centered perioperative care because he thinks it can success with ERAS (enhanced recovery after surgery) protocols and one multidisciplinary team. Hence, he initially coordinated ERAS team and implement ERAS in Cathay General Hospital in Taiwan since 2016. Furthermore, he worked on the establishment of Taiwan Chapter, ERAS Society in 2019. Through these years, more and more patients, HCPs, and hospitals indeed have received this concept and begun to change in clinical practices step by step. In addition to his clinical work, he spends time in the medical education about high-fidelity simulation and in the basic research in neuroscience. Different challenges in his life can keep him moving and inspire much energy. Dr. Guo’s passion is driven by his patients over the courses of their lives and is proud to work with his fantastic team of practitioners, too. ### Ravi Oodit (SA) ### Kate Dell (USA) Kate Dell is a board-certified Acute Care Nurse Practitioner in Vascular Surgery with Ascension Medical Group Indianapolis in Lafayette, Indiana. As a Nurse Practitioner, she manages Vascular disease patients throughout the perioperative phases of care within the inpatient and outpatient settings. She is involved with clinical research and her doctorate research focus was on improving the evaluation of patients with diabetic foot ulcers. Lastly, as a lead adjunct professor of Acute Care Nurse Practitioners, she enjoys developing course curricula and mentoring students. Kate is actively involved with multiple societies including the Society for Vascular Surgery (SVS), Midwestern Vascular Surgical Society (MVSS), American Association of Critical-Care Nurses (AACN), and American Association of Nurse Practitioners (AANP). She has held multiple volunteer roles including SVS Enhanced Recovery After Surgery Writing Group, the task force for the scope and standards for acute care nurse practitioners, peer reviewer for The Journal of the American Association of Nurse Practitioners, and AACN review panel for research grants. Kate believes in a patient-focused approach to providing high-quality evidence-based care with the goal of promoting health and preventing disease. Kate has engaged colleagues, surgeons, and anesthesiologists to adopt an ERAS approach to aortic and lower extremity artery bypass surgeries. She hopes to spread awareness of the positive impact this approach can have on patient outcomes and can continue to contribute to future research in the specialty of Vascular Surgery. ### Ashley K. Vavra (USA) Dr. Vavra is an assistant professor of vascular surgery at Northwestern University Feinberg School of Medicine and Service line Chief for Vascular Surgery at the Jesse Brown Veterans Administration Hospital in Chicago, IL. Dr. Vavra completed her training at Northwestern University in Chicago and she is board certified in both general and vascular surgery. As a vascular surgeon, she performs both open and endovascular surgery for a wide range of disorders with particular interest in both peripheral arterial disease and thoracic outlet syndrome. Dr. Vavra is currently an advocate for patient centered care in surgery and believes that the key to providing the very best care for patients is through promotion of a culture of safety and quality. In 2020 she completed a master’s degree in Healthcare Quality and Patient Safety at Northwestern University. She has also completed certificate training programs in quality improvement through the Institute of Healthcare Quality, Safety and Efficiency at the University of Colorado in 2015 and the Academy of Quality and Safety Improvement in 2021. Dr. Vavra is a health services researcher and has led multiple service line, hospital and system wide initiatives to improve the perioperative care for surgical patients, including enhanced recovery for patients undergoing lower extremity arterial bypass. ### Alberto Settembrini (Italy) Alberto Settembrini is vascular surgeon at Fondazione Policlinico in Milan, Italy and adjunct professor of vascular surgery at University of Milan. He achieved board in vascular surgery in Italy in 2013 and he is Fellow of European Board of Vascular Surgery since 2021. He is member of ESVS, SVS, SICVE, but also of vascular medicine and wound care societies. He is member of executive board of Italian Society of Young Surgeons and from 2011 to 2013 he has been in the board of EVST (Young European vascular surgeons). He is associate editor and reviewer for different journals of surgery and vascular surgery. His clinical and surgical experience is about all the topics of vascular surgery from aorta to peripheral arteries and venous diseases. About ERAS, his experience in Novara Hospital with Dr. Piero Brustia, pioneer in ERAS for aortic surgery, allowed to him to know, understand and deepen ERAS approach to aortic pathology. Thanks to this he took ERAS approach in all the centers where he worked till now. ### Marianna Ramona S. Sioson, MD ### Marie Jaymee S. Sanchez, RN ### Mattias Soop (Sweden) I am a surgeon specialising in the management of inflammatory bowel disease and intestinal failure. I completed general surgical training and a PhD in surgery in 2004 at the Karolinska Institute, Stockholm and Salford Royal Hospital, Manchester, UK, and then did a postdoc and a clinical fellowship in colorectal surgery at Mayo Clinic, Rochester, MN. I worked at The University of Auckland, NZ, and at the Irving National Intestinal Failure Unit at Salford Royal Hospital as a consultant surgeon and associate professor. In 2019, I returned to Stockholm to develop an IBD Centre at Ersta Hospital. I also serve as Section Editor at Diseases of the Colon and Rectum and on the ESPEN Scientific Committee. orcid.org/0000-0003-4287-6978  ### Karma Lambercy (Switzerland) Karma Lambercy is a medical attending in the Otolaryngology - Head and Neck Surgery at CHUV Lausanne in Switzerland. He undertook his training in Switzerland at Hospital du Pays d'Enhaut and Hospital du Valais. ### Prof Christian Simon (Switzerland) Prof Simon Professor and Chairman (Chef de service) of the Department of Otolaryngology – Head and Neck Surgery, at the University Medical Center Vaud (CHUV) and University of Lausanne (UNIL) in Switzerland since 2012. From 2018 to 2020 he was the chair of EORTC-HNCG. Alongside clinical fellowships at The University of Texas M.D.Anderson Cancer Center, Houston, Texas, Washington University in St. Louis,  Missouri, and University of Minnesota (USA) he trained at the University of Tuebingen, Germany. He worked as Consultant Surgeon (Oberarzt), Department of Otolarnygology – Head and Neck Surgery, University of Heidelberg, Germany before becoming the Vice-Chair in 2009.    ### Cheryl Crisafi (USA) ### Alexandra Hatchell (Canada) Dr. Alexandra Hatchell (MD, MSc, FRCSC) is an attending plastic surgeon at the Peter Lougheed Centre and Alberta Health Services and a Clinical Lecturer in the Department of Surgery at the University of Calgary (Calgary, Alberta, Canada). Dr. Hatchell graduated from Queen’s University in 2010 after earning a Bachelor of Physical and Health Education and a Bachelor of Science. Dr. Hatchell went on to obtain a Master of Science from Queen’s University in 2011, where her research focused on health messaging and behaviour change. Dr. Hatchell graduated with her medical degree from McMaster University in 2014 and completed her plastic surgery residency at McMaster University in 2019. Dr. Hatchell fulfilled a microsurgery fellowship with specialization in trauma reconstruction, oncologic reconstruction (breast, head and neck, and sarcoma), and peripheral nerve reconstruction at the University of Calgary in 2020. Throughout her training, Dr. Hatchell has developed a keen research focus in the areas of both patient-reported outcomes and functional outcomes in reconstructive surgery, and exploring factors that impact operative efficiency and enhanced postoperative recovery in the context of trauma and oncologic reconstruction. Dr. Hatchell’s clinical focus and interests include breast, oncologic, and traumatic reconstruction. ### Dorthe Hjort Jakobsen (Copenhagen) Dorthe Hjort Jakobsen has been working with developing and implementing ERAS program since 1997 together with Professor Henrik Kehlet. Her particular focus has been on broaden knowledge of fast-track/ERAS principles and supporting to standardize and improve the quality of the surgical care in Denmark by establishing Unit of Perioperative Nusing (2004-2012). The purpose of the unit was to work with coordination, teaching and knowledge sharing through an innovative multidisciplinary national network. This resulted in the development of 17 ERAS programs for the major surgical areas, which were available on a website. Since 2012 she has been Clinical Nurse Manager at the ERAS Unit at Copenhagen University Hospital, where the purpose is to improve the perioperative quality of care for all surgical procedures by ensuring updated ERAS procedure-specific, evidence-based programs. Her research interests have focused on implementation, convalescence following ERAS program and the impact on nursing care. Internationally she has been invited speaker at several congresses, and she has taken the initiative to establishing an international ERAS® nursing group (a part of the ERAS® Society). ### Dr Jessica George (USA) Dr. Jessica Anne George is an Assistant Professor of Pediatric Anesthesiology at Johns Hopkins University, where she is also Medical Director of the Pediatric Enhanced Recovery After Surgery program for the Department of Anesthesiology and Critical Care Medicine. Last fall, she was elected to the ERASPediatrics Board of Directors. She earned her medical degree from Thomas Jefferson Medical College in Philadelphia and completed her Anesthesiology residency at Albany Medical Center in Albany, NY. She continued her training with a Pediatric Anesthesiology fellowship at Johns Hopkins Hospital. While working as a Pediatric Anesthesiologist, she obtained her Master of Education in the Health Professions and has played an active role in the training of Anesthesiology residents and fellows. She was the assistant director for the JHH pediatric anesthesiology fellowship for 2 years, then the associate director for the JHH anesthesiology residency for 3 years. Recently, she assumed the role as the Program Director for the Pediatric Anesthesiology Fellowship at Johns Hopkins University. She has a passion for perioperative education of patients, parents, and health care professionals alike, and is ardent in her efforts to improve patient outcomes and decrease mortality and morbidity in the clinical environment. ### Dr Didier Roulin (Switzerland - Pancreas) Dr. Didier Roulin is a senior fellow in Hepato-Pancreato-Biliary (HPB) surgery at Lausanne University Hospital (CHUV) in Switzerland. He is also holding a position of senior lecturer and Privat Docent at Lausanne University. He has been actively involved in Enhanced Recovery After Surgery (ERAS) for more than ten years with more than twenty publications and book chapters in this field. He is also implicated in the implementation of enhanced recovery programs in different countries. ### Dr Gaëtan-Romain Joliat (Switzerland - Liver) Dr Gaëtan-Romain Joliat graduated from the medical school of the University of Lausanne (UNIL) in Switzerland and is also certified by the Educational Commission for Foreign Medical Graduates (ECFMG) in the United States. He received his medical doctorate (MD) in 2015 from the same university. He obtained the Swiss board certification (FMH) in general surgery after completing his clinical training at Lausanne University Hospital (CHUV, Lausanne, Switzerland) in 2019, where he presently works as a surgeon. His research interests are the prediction and prognosis of postoperative complications and survival after pancreas surgery, Enhanced Recovery after Surgery (ERAS) in hepatopancreatobiliary surgery, liver and pancreas cancers, and hepatic alveolar echinococcosis. Dr Joliat was involved in the update of the ERAS guidelines for perioperative care for liver surgery. He has written more than 50 peer-reviewed articles and has presented his work to several international and national meetings. He is member of the editorial board of the AME Medical Journal and reviewer for several high-impact journals. He is currently PhD candidate in Health Sciences at the University of Bern, Switzerland. ### Delia Cortés Guiral (Spain) Delia Cortés Guiral was born in Huesca, Spain. She is a specialist in peritoneal surface malignancies, certified and first promotion of European School of Peritoneal Surface Oncology (Washington, 2016). Specialist in Cytoreductive Surgery, HIPEC (hyperthermic intraperitoneal chemotherapy) and PIPAC (pressurized aerosolized intraperitoneal chemotherapy). Her training and interest in minimally invasive surgery positioned her as an active surgeon in the development and promotion of laparoscopic peritonectomy, she organized the first worldwide course on Laparoscopic Management of Peritoneal Disease (Spain, 2019) on the auspice of ESSO (European Society of Surgical Oncology),  EYSAC (ESSO Young Surgeons Alumni Club ) and SEOQ (Spanish Society of Surgical Oncology). Specialist in colo-rectal cancer. Dr. Delia Cortes-Guiral has been responsible for @SoMe4Peritoneum media content (Twitter community) since 2019 and she is really committed to globalization of surgical knowledge through social media and educational channels. She’s served as a member of the Steering Committee of EYSAC since 2017 and was appointed to the ESSO Board of Directors during the Extraordinary General Assembly of 15th June 2020. As a member of the Steering Committee of EYSAC (2017-2021) she has contributed organizing two hands-on courses on thyroid and on MIS in peritoneal disease, among other initiatives. Member of the board of directors of SEOQ 2017-2021 (Spanish Society of Surgical Oncology), Member of the board of FESEO 2019-2020 (Spanish Federation of Associations of Oncology), member of the Communication Committee of the ISSPP since 2019 (International Society for the Study of Pleura and Peritoneum) and the Communication Committee of the AEC 2019-2020 (Asociación Española de Cirujanos). Member of the Editorial Advisory Board of Colorectal Disease and member of the Media Editor Committee for Surgery journal. ### Steven Bisch (Canada) Dr. Steven Bisch is a gynecologic oncologist at the Tom Baker Cancer Centre in Calgary, Alberta, Canada. He completed his medical doctorate as well as his Residency in Obstetrics and Gynecology at the Schulich School of Medicine in London, Ontario, Canada. He completed his fellowship in Gynecologic Oncology at the University of Calgary in Alberta, Canada while concurrently obtaining his Masters of Public Health in Clinical Effectiveness from the Harvard T.H. Chan School of Public Health. His current research interests include perioperative quality improvement, onconutrition, and health information technology in oncology. He has recently moved back to Calgary and is excited to join the Gynecologic Oncology team at the Tom Baker Cancer Centre where he hopes to continue to work to develop ERAS programs across numerous specialties. ### Alex Gregory (Canada) ### Saum Ghodoussipour (USA) Saum Ghodoussipour is a Urologic Oncologist and Assistant Professor of Surgery at the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School in New Brunswick, New Jersey, USA. His clinical areas of expertise include complex open and robotic surgeries of the pelvis and retroperitoneum. This includes removal of the bladder (radical cystectomy) with reconstruction of the urinary tract to maximize functional recovery, nerve-sparing procedures to maintain sexual function and fertility, advanced vascular techniques for invasive tumors and open extraperitoneal procedures to hasten recovery. His research is focused on methods to facilitate treatment decisions for patients before and after surgery, surgical techniques to optimize oncologic and functional outcomes and the development and implementation of perioperative care pathways to enhance recovery after surgery. ### Dr. Sia Daneshmand (USA) Dr. Sia Daneshmand is currently Professor of Urology with Clinical Scholar designation and serves as director of clinical research as well as the urologic oncology (SUO) fellowship director at the University of Southern California (USC) in Los Angeles. His main interests include bladder cancer, advanced kidney cancer and testicular cancer. He is a leading authority in the management of complex germ cell tumors and nerve-sparing retroperitoneal lymph node dissection (RPLND) following chemotherapy for advanced testicular cancer and is one of the highest volume surgeons for this disease in the country. His main research interests focus on the use of pathways to improve peri-operative outcomes following radical cystectomy and post-chemo RPLND, use of serum and molecular markers and new technologies in diagnosis and management of bladder and testicular cancers, as well as functional outcomes following orthotopic urinary diversion. He serves on the editorial board of the Journal of Urology, Bladder Cancer Journal, Current Opinions in Urology, the scientific advisory board of Bladder Cancer Advocacy Network (BCAN) as well as the AUA/SUO Guideline Committee on testicular cancer as well as non-muscle invasive bladder cancer. He was recently elected chair of the SUO Clinical Trials Consortium (SUO-CTC) bladder organ committee and serves as the Secretary of the Western Section of the AUA. He is a member of Alpha Omega Alpha medical honor society and has been designated one of the “America’s Top Cancer Doctors” for the past 11 consecutive years. He is an active member of the Society of Urologic Oncology, has presented over 400 abstracts at scientific meetings and has authored over 300 peer-reviewed articles, reviews, and book chapters. ### Peter Mac ### Professor Luiz Falcao (Brazil) Luiz is an Associate Professor at Dept. of Anesthesiology, Pain and Critical Care Medicine, Paulista Medical School - Federal University of Sao Paulo (EPMUNIFESP) and Professor, Lisbon University, Portugal. He is also Scientific Director, São Paulo Society of Anesthesiologists, SAESP Board of directors, International Society of Perioperative Care for Obesity Patient, ISPCO ### Dr Santiago Mc Loughlin (Argentina) Santiago is a Staff anesthesiologist at Hospital Italiano de Buenos Aires, Argentina. ### Dr Kevin Elias (USA) Kevin is Assistant Professor, Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School and Director, Gynecologic Oncology Laboratory, Division of Gynecologic Oncology, Brigham And Women's Hospital, Boston, USA. His laboratory focuses on the prevention, diagnosis, and treatment of women with gynecologic cancers. The group includes a mixture of gynecologic oncology fellows, post-doctoral PhDs, technicians, and support staff. The thrust of thier work is devoted to the early diagnosis of ovarian cancer, novel treatment approaches based on polymer chemistry, and in vivo models of gynecologic malignancies, including choriocarcinoma and ovarian cancer. ### Dr Alfie Adiamah (UK) Alfie is a past NIHR Academic Clinical Fellow and Specialty Registrar in General Surgery. He is currently enrolled on a doctoral programme at the University of Nottingham, UK, investigating postoperative outcomes using epidemiological study design. His other research interest is on the potential role of nutrition and nutritional adjuncts on surgical outcomes. He spends his free time, supporting Leicester Tigers and Manchester United football club. ### Dr Ane Abad-Motos (Spain) Ane is a Consultant in Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain. Member of the Spanish Society of Multimodal Surgical Rehabilitation (GERM). She coordinated and coauthored POWER 1 (Postoperative outcomes within an Enhanced Recovery After Surgery protocol in colorectal surgery) and POWER 2 (Postoperative outcomes within an ERAS protocol in Total Knee or Hip Replacement), published in JAMA Surgery in 2019 and 2020. Papers: The POWER studies: Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R, Aldecoa C, Abad-Motos A, Logroño-Egea M, García-Erce JA, Camps-Cervantes Á, Ferrando-Ortolá C, de la Rica AS, Cuellar-Martínez A. Association between use of enhanced recovery after surgery protocol and postoperative complications in colorectal surgery: the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) study. JAMA Surgery. 2019;154:725-36. And Ripollés-Melchor J, Abad-Motos A, Díez-Remesal Y, Aseguinolaza-Pagola M, Padin-Barreiro L, SánchezMartín R, Logroño-Egea M, Catalá-Bauset JC, García-Orallo S, Bisbe E, Martín N. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA surgery. 2020;155:e196024-. ### Dr David Humes (UK) David is an Associate Professor of Surgical Epidemiology and Honorary Consultant Colorectal Surgeon at the University of Nottingham School of Medicine, UK. His research interests focus on the use of routinely collected data to study the epidemiology of surgical disease. His current projects include work on surgical training, diverticular disease and venous thromboembolism. His clinical interests are surgery for colorectal and anal cancer. ### Professor Andy Klein (UK) Andrew Klein is a Cardiothoracic Anaesthetist at Royal Papworth Hospital in Cambridge, UK. He is the Editor-in-Chief of Anaesthesia and is on the Board and Council of the Association of Anaesthetists, the membership organisation for > 11,000 anaesthetists in Great Britain and Ireland. He sits on the Board and Council of the National Institute of Academic Anaesthesia (NIAA), which manages research grant funding in the UK and is also a member of the research committee for the Australian and New Zealand College of Anaesthetists (ANZCA). Andrew’s main research area is pre-operative anaemia and the effects of iron replacement therapy. Andrew is a keen cricket supporter and member of the Marylebone Cricket Club (MCC) at Lord’s in London, and a lifelong and long-suffering West Ham United Football Club season ticket holder. Paper: Richards T, Baikady RR, Clevenger B ….. and Klein AA. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. The Lancet. 2020;396:1353-61 ### Professor Mike Grocott (UK) Mike Grocott is the Professor of Anaesthesia and Critical Care Medicine at the University of Southampton, UK, director designate of the Southampton NIHR Biomedical Research Centre (2020-2025) and an NIHR Senior Investigator. He is the UK NIHR Clinical Research Network national specialty lead for Anaesthesia Perioperative Medicine and Pain (2015-21) and an adjunct professor of Anesthesiology at Duke University School of Medicine in North Carolina (USA) and an honorary professor at University College London and King’s College London. He is vice-chair of the board of the new national multidisciplinary Centre for Perioperative Care (CPOC) and an elected council member of the Royal College of Anaesthetists (2016- 22). He chairs the board of the National Institute of Academic Anaesthesia (2018-21) and is joint editor-in-chief of Perioperative Medicine. ### Prof Teo Li Tserng (Singapore) Dr. Teo Li-Tserng is a practicing Trauma and General Surgeon in Tan Tock Seng Hospital (TTSH). He has been involved in trauma and acute surgical care in Tan Tock Seng Hospital since 2005. Other than trauma and acute care surgery, his other subspecialty interest is in colorectal surgery. He was appointed Chief of Trauma and Acute Care Surgery in 2013 and subsequently the Director of Trauma Service in TTSH and Director, Central Region Trauma Services, Singapore in 2019. In addition to improving clinical trauma and acute care in the hospital, he has instituted formal trauma audits and trauma teaching. In 2006, during the Yogyakarta Earthquake, he led a combined civilian and military specialist surgical team to supplement humanitarian efforts. He has co-ordinated medical evacuations and humanitarian relief missions that Tan Tock Seng Hospital was involved in. ### Ms Catherine Sinton (Australia) Catherine Sinton BNurs Deakin, GDipNP Melb has been in the role of ERAS® Liaison Nurse at the Peter MacCallum Cancer Centre Melbourne, Australia for 2 years. She has been practising nursing as a clinical nurse specialist and associate nurse unit manager for over 20 years, and has an extensive background in anaesthetics, recovery and intensive care nursing. She has special interest in prehabilitation, specifically patient optimisation and education. ### Dr Georgina Christelis (Australia) Dr Georgina Christelis is an anaesthesiologist at the Peter MacCallum Cancer Centre, Melbourne. She is the lead Anaesthetist for Enhanced Recovery and joint lead for Pre Anaesthetic Clinic. She has a specialist interest in perioperative assessment, optimisation and management of the high risk surgical cancer patient. She strives for best multidisciplinary collaboration to achieve readiness for patients prior to surgery, their return to intended oncolgic treatment and best outcomes. ### Professor Bernhard Riedel (Australia) Bernhard is the Director of the Department of Anesthesia, Perioperative and Pain Medicine at the Peter MacCallum Cancer Centre, Professorial Fellow at the University of Melbourne, and Clinical Associate Researcher at the Cancer & Neural-Immune Research Laboratory, Monash Institute of Pharmaceutical Sciences, Australia. Bernhard’s research interests have improved the understanding of perioperative factors that contribute to complications following major surgery—with strategies for enhanced risk stratification (including measuring functional capacity with cardiopulmonary exercise testing) and preoperative optimization (including prehabilitation with exercise therapy) to reduce complications after surgery. Specific to the field of onco-anaesthesia, Bernhard’s research collaborative investigates the interaction of perioperative adrenergic-inflammatory response and anaesthetic technique on tumorprogression signaling on the potential long-term postoperative complication— cancer recurrence ### Kate McGinigle (USA) Dr. McGinigle is an Associate Professor of Surgery and the Director of the Enhanced Recovery Program at the University of North Carolina at Chapel Hill. As a practicing vascular surgeon, she performs open, endovascular, and hybrid techniques for the breadth of vascular conditions, but has a special clinical and research interest in chronic limb threatening ischemia (CLTI). Her funded research focuses on using precision medicine to define adaptive treatment strategies for patients with CLTI and to address unwarranted care variation and healthcare disparities facing that patient population. Dr. McGinigle is an Executive Council member for the Enhanced Recovery After Surgery USA Society and serves as chair of the Research Committee and a member of the Protocols and Guidelines Committee in that society. She is the chair of the Society for Vascular Surgery (SVS) Enhanced Recovery Working Group, and serves as a member of the SVS Document Oversight Committee, the Pain Management Task Force, and the Public Health Task Force. She is also on the Governing Council of the SVS Vascular Quality Initiative and the Medical Director of the Carolinas Vascular Quality Group. ### Kim Mortensen ### Don Low ### Henriette Smid-Nanninga Henriëtte Smid-Nanninga has more than 21 years of experience as a nurse in the surgical department. She works in the Martini Hospital in Groningen. Since 2016 she has been working there as ERAS coordinator. In addition to her role as ERAS coordinator, since 2018 she has also been tasked with bringing nursing research and Evidence Based Practice (EBP) to a higher level. EBP and ERAS is a valuable combination for nurses and allied health professionals. In 2020 she graduated as a clinical epidemiologist at the University of Amsterdam. Her mission is to get more nursing and allied health research and EBP done focused on ERAS and daily practice. ### Emmanuel Melloul (Switzerland) Dr. Emmanuel Melloul was born and raised in Switzerland, and received his medical degree at Lausanne University. He is a Hepatobiliary (HPB) and Pancreatic surgeon, and completed his General Surgery at the university hospital of Lausanne (Switzerland), and HPB fellowship specialty training at the university hospital of Beaujon (Paris, France) and Icahn school of Medicine of Mount Sinai Hospital in New York. He received the European board of Surgery Qualification (EBSQ) in HPB surgery. He is currently attending HPB surgeon at the University hospital in Lausanne in Switzerland with a position of senior lecturer and Privat Docent at the University of Biology and Medicine. His research interests are liver oncology, liver regeneration, and Enhanced recovery after liver surgery. He has written more than 50 peer-reviewed articles and several book chapters and is member of the editorial board of the journal Medicine and reviewer in distinguished journals such as Annals of Surgery and Journal of Hepatology. He has also been nominated to sit on the Scientific Programme Committee of the E-AHPBA in 2021. ### Geeta Aggarwal (UK) Geeta is a consultant anaesthetist at Royal Surrey County Hospital in Guildford, Surrey. Her major interests are emergency and high risk surgery and quality improvement. She worked as a clinical research fellow on the Emergency Laparotomy Collaborative and worked as a National Advisor for ELC England and Emergency Laparotomy Cymru. She helped lead the work on sepsis at RSCH and Kent Surrey and Sussex. She is currently working towards an MD in improving outcomes for older patients undergoing emergency surgery. ### Carol Peden ### Claire Temple-Oberle (Canada) Dr. Temple-Oberle is a University of Calgary Professor cross-appointed to the Departments of Oncology and Surgery, with a special interest in reconstructive plastic surgery. She completed her MD at Queen’s University, a plastic surgery residency at the University of Western Ontario, and fellowships at MD Anderson Cancer Center in reconstructive microsurgery and surgical oncology at the Tom Baker Cancer Centre. Prior to joining the University of Calgary team, Dr. Temple-Oberle worked in the Departments of Surgery and Oncology at University of Western Ontario from 2003 to 2011. During this time, she completed an MSc in Epidemiology at the Harvard School of Public Health. She has recently completed her Masters of Medical Education through the University of Dundee. Dr. Temple-Oberle’s current practice specializes in oncological reconstruction, particularly in breast cancer and melanoma. She conducts research focused on improving the quality of life for breast cancer survivors, integrating technology and ERAS protocols to improve surgical outcomes and patient experience, and medical treatment of in-transit melanoma. Her current focus is surgical prevention of lymphedema in cancer surgery patients by using microsurgical technique to reroute the lymphatic system through the venous system. In addition to her oncological work, Dr. Temple-Oberle is also an advocate for access to surgical treatment of body dysmorphia for transgender individuals. ### Erik Stenberg Erik Stenberg is currently working as a consultant surgeon at Örebro University Hospital and Lindesberg hospital in Sweden. He is also appointed associated Professor at Örebro University. He was the first author of the 2021 updated guidelines for ERAS Bariatrics. ### Tracy Wasylak, RN Tracy Wasylak is the Chief Program Officer, Strategic Clinical Networks™ with Alberta Health Services. She has held numerous senior leadership roles within Alberta Health Services. Tracy holds an adjunct assistant professor appointment with the Faculty of Nursing at the University of Calgary. She is the Co-Lead for the ABSPORU 2.0 Learning Health System Platform. Tracy received the Order of Merit, Nursing Policy Award, from the Canadian Nurses Association in March 2018. She was the recipient of the 2015 AHS Presidents Excellence Award in the category of Innovation and in 2019 she received the award for Outstanding Achievement in Quality Improvement for her provincial contributions to care pathways. ### Dr Eivind Warberg (Norway) ### Florencia Faber (CAMOC) ### Dr Marcelo Viola (Uruguaya) ### Björn Wellge (Germany) ### My Liljenberg (Sweden) ### Dr Ed Mariano (USA) ### Felicia Cox RN (UK) ### Professor Pam Macintyre (AUS) ### Dr Nicholas Levy (UK)   ### Dr Jane Quinlan (UK) ### Professor Sean Dowdy (UK) ### Mr Garry Laxdal (Canada) Garry Laxdal is from Calgary. He has successfully battled rectal cancer from six years ago. Garry is now a Patient Advisor with the Surgical Strategic Clinical Network with Alberta Health Services. He is also the Co-Chair of the Patient Engagement Reference Group within AHS as well. Garry has had the privilege of speaking for Enhanced Recovery After Surgery and the benefits of practicing Mindfulness at several conferences. Garry is a former owner of a technology company with offices throughout Western Canada and is now employed by Telus. ### Professor Mary Brindle (Canada) Mary Brindle is a pediatric surgeon and Professor or Surgery and Community Health Sciences at the University of Calgary in Alberta Canada. She is also the Scientific Director of the Alberta Surgery SCN and the Director of the Safe Surgery Safe Systems Program at Ariadne Labs, TH Chan Harvard School of Public Health in Boston. She currently leads work to optimize the performance of the WHO Surgical Safety Checklist and works within the ERAS® Society to help advance the rigor and scope of international ERAS® guidelines and develop strategies to improve the implementation of ERAS® pathways on neonatal surgical units. ### Pat Trudeau (Canada) Pat Trudeau is a Registered Nurse working with the Enhanced Recovery After Surgery (ERASAlberta) Provincial Coordination Team under the Surgery Strategic Clinical Network™ for Alberta Health Services in Alberta, Canada. She has practiced for over 30 years as a front-line provider, educator and manager. Pat has significant experience in post-surgical care including Neurosurgery and Trauma, with 16 years specialized in Gynecologic Oncology and Gynecology. She is a Prosci® Certified Change Practitioner. Pat has experience working within multi-pathways and considers her leadership for the implementation and sustainment of the ERAS® care pathways for Gynecologic Oncology and Gynecology to be her most significant contribution. She is currently working with the team roll-out to the HIPEC patient population. Pat’s concern for the patient experience guides this quality improvement work, always coaching to ensure that care is delivered safely, skillfully and compassionately ### Kristina Wikander Kristina is responsible for ERAS® Society’s secretariat since 2012 with focus on providing good and fast service to all in ERAS® network throughout the world. She is a medical secretary with many years of experience from hospital and in occupational health, and has worked as a school leader at the Swedish school in Hamburg, Germany and has been a hotel owner in southern France. ### Professor Tonia Young-Fadok, M.D. (USA) Professor Tonia Young-Fadok, M.D. had her Pre-clinical and Clinical Medical School at Oxford University, England. She was a Harvard Surgical Research Fellow at New England Deaconess Hospital, Boston, US. She did her residency at St Elizabeth's Medical Center, Boston, then ACGME CRS fellowship at Mayo Clinic, Rochester, followed by laparoscopic CRS fellowship. Professor Young-Fadok holds a Harvard School of Public Health for Masters degree in Epidemiology, prior to joining staff at Mayo Clinic, Rochester. Subsequently she moved to to Mayo Clinic, Arizona. She is a past Board Member of SAGES, SSAT, Fellowship Council, ISS and ISDS and current Board member of ERAS® USA. Past President of ISDS and founding President of ERAS®USA. She is currently serving as the Chair of CRS at Mayo Clinic Arizona, and Director of our ERAS® Center of Excellence. ### Dionisios Vrochides (USA) ### Nader Francis (UK) ### Robin Kennedy (UK) ### Fredrik Hjern (Sweden) ### José Ramirez (Spain) Professor José Ramírez qualified from the Zaragoza Medical School, did the Surgical Training at the University Hospital at the same time he performed the PhD that was accomplished with the highest qualifications in 1992. In 1993, he was fellow at the Department of Colorectal Surgery in Oxford (UK) thanks to a grant from the Spanish National Health Service. In 1994 he did a fellowship in minimal invasive surgery at the Department of Surgery of Tubingen (Germany) granted by the Deutscher Akademischer Austauschdienst. In 1995 returned to Zaragoza as Consultant surgeon and started a clinical and research programme in minimal invasive surgery and colorectal surgery. He has published over 200 original papers and has participated as invited speaker in more than 100 scientific meetings. He created the Colorectal Unit at the Department of Surgery. Related to the University since 2001, he is the director of several International courses (Master in Coloproctology, Ultrasound for surgeons, rectal and anal ultrasound, Transanal endoscopic Microsurgery…) as well as the owner of different educational webs.He is the leader, and principal researcher of the Research group in Perioperative Surgery, which is associated to the Aragon Institution for Research and development (IACS). He has been an active member of the steering Group of the Spanish Society of Coloproctology, and in 2007 founded the Spanish Group in Enhanced Recovery (GERM) holding up its leadership. Chairman of the educational committee of the ERAS® Society, was president of II World Congress in Valencia 2014. Recently has published the Spanish Guidelines on perioperative surgery supported by the Spanish National Health Ministry and is on charge of the Spanish ERAS® National implementation project. ### Maria Manso (Portugal) ### Marie Jaymee Sosa-Sanchez (Phillippines) ### Andrew Hill (New Zealand) ### Daniel Enciso (Mexico) ### Angela Navas (Colombia) ### Professor Cornelius De Jong (The Netherlands) ### Professor Franco Carli (Canada) Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University. Staff anesthesiologist at the McGill University Health Centrel. Previously Wesley Bourne Professor and Chairman of the McGill Department of Anesthesia (1994-2004) Gold Medal, Canadian Anesthesiologists Society. Elected Member of the American Academy of Anesthesia. Founder and President of the Peri-Operative Program. His research interests are: metabolic response to surgical stress, enhanced recovery after surgery and prehabilitation of surgical patients. He is the author of over 250 peer-review scientific articles, a recipient of over 50 peer and non peer-review grants and lectures worldwide on ERAS and prehabilitation. ### Professor Arthur Revhaug (Norway) Professor Arthur Revhaug is a Co-funding member of the ERAS Study Group and later the ERAS® Society. He has been a member of the Board since the start and from 2016 chairman of the ERAS® Society Board. As a long time head of a university hospital surgical department and university research group, his mantra for the work with ERAS has been ”maximum multiprofessional collaboration for the patients best”. His research main focus has been on surgical patophysiology and the development of Enhanced Recovery After Surgery (ERAS) documentation and implementation. Professor Revhaug has authored more than 160 peer-reviewed publications and has regularly been an invited lecturer internationally.  ### Dr Leigh Kelliher (UK) ### Tom Barnes (UK) ### Emma Stewart (UK) ### Ben Morrison (UK) ### Katie Wimble (UK) ### Tim Batchelor MBChB BSc MSc FRCS(CTh) (UK) Tim Batchelor graduated from Edinburgh University Medical School in 1995 and went on to train in cardiothoracic surgery in Scotland and Yorkshire. In 2007 he was appointed as a consultant in thoracic surgery at Bristol Royal Infirmary in the South West of England.   An interest in pre-operative assessment led to the introduction of enhanced recovery after surgery (ERAS) in 2010, one of the first thoracic units in the world to do so. At the same time, Bristol became established as a European training center for minimally invasive thoracic surgery.   Tim is the lead for thoracic surgery within the ERAS Society and the lead author for the guidelines for ERAS after lung cancer surgery. He also sits on the thoracic sub-committee for the European Association for Cardiothoracic Surgery. In addition, he is on the guideline writing group for the European Respiratory Society/European Society for Thoracic Surgery guidelines on assessing fitness for radical lung cancer treatment. He has an active role in research and is either a co-applicant or principle investigator for a number of national multicenter RCTs. ### Daniel T. Engelman MD, FACS (USA) Dr. Engelman is the Medical Director of the Heart, Vascular and Critical Care Units at Baystate Medical Center. He is a Professor of Surgery at The University of Massachusetts-Baystate. He started the ERAS® Cardiac Collaborative to internationally standardize best practices. He is the President of the Massachusetts Society of Thoracic Surgeons (STS) and serves on multiple Statewide Oversight committees. He wrote two guidance manuscripts on COVID-19 for the Society of Thoracic Surgeons. Dr. Engelman participates on three national workforces for the STS and the American Association of Thoracic Surgery and writes board questions for Cardiac Surgical Certification. He was the Past President of the 21st Century Cardiothoracic Surgical Society. He also serves on the Board of Directors of the Baycare PPO and ACO and is Vice President of the local Independent Physician Organization. Dr. Engelman is the principal investigator on multiple research projects, has published over 100 peer-reviewed publications, and participates on two international taskforces (ADQI and KDIGO) standardizing approaches for the prevention of postoperative acute kidney injury. He travels extensively lecturing on advances in critical care medicine, healthcare informatics and finance, multimodal analgesia, and enhanced recovery after cardiac surgery. In 2016 Dr. Engelman was named the National ACS/STS Health Policy Scholar. He is a graduate of the Executive Leadership Program in Health Policy and Management at Brandeis University. He completed his Cardiothoracic Surgical training at Brigham & Women's Hospital, Harvard University, in Boston. He received his B.A. with honors from the University of Pennsylvania and M.D. from the New York University School of Medicine ### Anders Thorell Professor of Surgery, Karolinska Institutet, and Consultant surgeon, Ersta Diakoni. Research topics Metabolism, mainly in relation to surgical stress. Muscle physiology, in particular glucose metabolism and the effects of exercise. Evaluation of surgical techniques in various aspects of upper gastrointestinal surgery Obesity, in particular effects of bariatric surgery with its underlying mechanisms   Publications Approximately 180 original articles in peer reviewed publications, 55 review articles and book chapters H-index 54 (Scopus)   Lectures Invited lecturer, approximately 4-6 invitations annually to national/international meetings during the last 5 years.   Funding Over the last 10 years recipient of grants from national foundations in the range of 600 000 Euros annually. ### Kirsti Fosland (Norway) ### Debbie Watson (Canada) ### Professor Tom Wainwright (UK) Tom Wainwright is Professor in Orthopaedics at Bournemouth University, and a Research Physiotherapist at University Hospitals Dorset NHS Foundation Trust.   He is a physiotherapist, clinical academic, and quality improvement specialist internationally recognised for his work on Enhanced Recovery after Surgery (ERAS) protocols within orthopaedics. Tom graduated as a physiotherapist from Coventry University with a first class degree and went on to specialise in orthopaedic physiotherapy. Tom moved into clinical research and has extensive experience of managing international randomised clinical trials in orthopaedics. In addition to his clinical and research work he has held managerial roles within the National Health Service (NHS) including a crucial leadership role in the design, implementation, and delivery of an award winning orthopaedic ERAS pathway. He is passionate about improving the quality of healthcare systems and works to help other healthcare providers improve the quality of their services. The Institute of Consulting named him as the 2010 young consultant of the year for his work on a portfolio of ERAS implementation projects. More recently, Tom has focussed on research within the field of ERAS and orthopaedics, and to date has secured over £2.5M in research income for projects in this area. He lectures worldwide and has authored numerous ERAS publications; including articles, textbooks, textbook chapters, and has won international prizes for his work. ### Dorthe Hjort Jakobsen, RN, MCN Dorthe Hjort Jakobsen has been working with developing and implementing ERAS® program since 1997 together with Professor Henrik Kehlet. Her particular focus has been on broaden knowledge of fast-track/ERAS principles and supporting to standardize and improve the quality of the surgical care in Denmark by establishing Unit of Perioperative Nusing (2004-2012). The purpose of the unit was to work with coordination, teaching and knowledge sharing through an innovative multidisciplinary national network. This resulted in the development of 17 ERAS programs for the major surgical areas, which were available on a website.  Since 2012 she has been Clinical Nurse Manager at the ERAS® Unit at Copenhagen University Hospital, where the purpose is to improve the perioperative quality of care for all surgical procedures by ensuring updated ERAS procedure-specific, evidence-based programs. Her research interests have focused on implementation, convalescence following  ERAS® program and the impact on nursing care.  Internationally she has been invited speaker at several congresses, and she has taken the initiative to establishing an international ERAS nursing group (a part of the ERAS® Society).  ### Jonas Nygren (Sweden) ### Pedro T. Ramirez, MD (USA) ### Sean C. Dowdy, MD (USA) ### Joseph C. Dort MD (Canada) ### Dr Mustapha Adham (France) ### Dr Yannick Cerantola, MD, FEBU (Switzerland) ### Dr Chris Jones (UK) Chris has been a Consultant Anaesthetist at the Royal Surrey County Hospital and St Luke’s Cancer Centre in Guildford, UK, since 2013. His training in anaesthesia was based at St George’s in London and he completed further specialist training in high risk and major oncology anaesthesia at Royal Surrey County Hospital; paediatric intensive care at the Evelina hospital and St George’s Hospital London; liver anaesthesia at King’s College London, and prehospital care in Sydney Australia. He has a keen interest in research and anaesthesia for major oncology surgery including HPB, OG and major urology. He also has a passion for Perioperative medicine and Enhanced Recovery for Surgery and was a module lead for the Perioperative medicine MSc course at University College London. He has designed ERAS® protocols for liver surgery and major urology surgery, including robotic cystectomy. He was awarded his MD (Res) from the University of Surrey in 2015 and his thesis was on Enhanced Recovery for open liver resection surgery. He has lectured worldwide and has numerous publications in the field of ERAS ### Professor William Fawcett (UK) Professor Bill Fawcett is a Consultant in Anaesthesia and Pain Medicine, Royal Surrey County Hospital Guildford, UK. and is currently Vice President of The Association of Anaesthetists of Great Britain and Ireland. A major area of research interest has been the use of regional anaesthesia in patients undergoing liver and colorectal resections as well as respiratory physiology, and reversal of neuromuscular blockade, producing nearly 200 publications. He is an Editor for BJA Education, a National Assessor and chapter writer for The Confidential Enquiries into Maternal Mortality (MBBRACE-UK). Closely involved with ERAS® Society, he has held appointments at The Department of Health, UK and latterly as Executive Committee member and a website editor for the ERAS® Society. He is currently Vice President of The Association of Anaesthetists of Great Britain and Ireland, and their Featherstone Professor. ### Associate Professor Ulf Gustafsson (Sweden) Ulf is a Senior consultant surgeon, specializing in colorectal surgery, laparoscopic and robotic surgery. He is the head of the division of Coloproctology, Center for Digestive Diseases Karolinska University Hospital & Karolinska Institutet He is Research group leader, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden. He is an experienced surgeon having completed more 5000 surgical procedures. His research has focused on Impact of ERAS on peri-and post-operative outcomes, perioperative interventions, glucose metabolism and surgery, robotic surgery and its impact on surgical outcomes, microbiota and psychiatric outcomes and microbiota and gastrointestinal disease. He has been lead author of lead of international ERAS guidelines, Board member and head of research design in SWERAS® RAS (Swedish ERAS® Society). He holds many national positions including Chairman: Scientific and Care program of colorectal cancer, region Stockholm-Gotland, Sweden, Expert surgeon, the Swedish council for national medical knowledge management (NPO) and Member of the executive committee, National program for colorectal cancer in Sweden. ### Professor Adrian Alvarez (Argentina) Adrian is a general surgeon and anesthesiologist. He works as a staff anesthesiologist at Hospital Italiano de Buenos Aires. His major achievements include Founder President of Perioperative Care of the Obese Patient (ISPCOP) www.ispcop.org, and founder and president ERAS® LATAM. (ERAS® Society Latinamerican Chapter, https://www.eraslatam.org), Vice President of Implementation, ERAS® Society. Contact Email: tatotatun@gmail.com, lorena.ruffini@encare.se ### Professor Gregg Nelson (Canada) Professor Gregg Nelson is Deputy Head of the Department of Obstetrics & Gynecology at the Cumming School of Medicine in Calgary, Alberta, Canada and is Chief of Gynecologic Oncology at the Tom Baker Cancer Centre. His principal research interests are the development and study of Enhanced Recovery After Surgery (ERAS) protocols in OB-Gyn and cancer surgery. He holds the position of Surgical Lead, ERAS® Alberta and he also leads the ERAS® Society Women’s Health Chapter that published the ERAS® Guidelines for Gynecologic/Oncology Surgery, ERAS® Guidelines for Cesarean Delivery, and ERAS® Guidelines for vulvar and vaginal surgery. Professor Nelson has authored over 150 peer-reviewed publications, and is the editor of the upcoming ERAS® Society Handbook for Obstetrics & Gynecology (Elsevier). He has presented numerous times internationally, serves on the Editorial Board of the International Journal of Gynecological Cancer and is the Secretary of the ERAS® Society. ### Dr Ravi Oodit (South Africa) Ravi Oodit is a general surgeon, Cape Town, South Africa. He has an interest in surgical gastroenterology, laparoscopic surgery and the Enhanced Recovery After Surgery (ERAS) Program. He is the African lead for the ERAS® program and the Perioperative lead in the Global Surgery Unit at University of Cape Town. He is passionate about extending the ERAS® program to LMIC’s. To this end he has worked with the ERAS® Society and leaders in South American and the Asia. He has partnered with the Southern Africa Development Community, the World Bank and the Global Surgery Foundation to improve perioperative care with the vision to develop a collective, innovative, locally relevant perioperative care platform for LMIC’s. ### Professor Nicolas Demartines (Switzerland) Nicolas Demartines obtained his MD degree at the University of Geneva in 1985, and achieved his board of Surgery in 1990 at the University of Basel Medical School, Switzerland. He has been Professor of Surgery, and Chairman of the Department for Visceral Surgery at the University Hospital CHUV in Lausanne, Switzerland, since 2006. His clinical and surgical activities are focused on oncologic surgery, mainly hepato-pancreatico-biliary and colorectal surgery and Upper GI. He is a former Treasurer to the ERAS® Society and Chairman of the ERAS Implementation Program. ### Dr Kwang Yeong How (Singapore) Dr How Kwang Yeong is a consultant surgeon in the Colorectal Service of the General Surgery Department, Tan Tock Seng Hospital. He specializes in minimally invasive surgery, including endoscopic, laparoscopic and robotic techniques for the treatment of colon and rectal conditions. He also completed a fellowship for advanced and recurrent pelvic cancers. Dr How is a strong advocate for ERAS. He played a key role in establishing the ERAS® program in Tan Tock Seng Hospital, which is one of only 2 Centres of Excellence in recognized in Asia by the international ERA® Society. He is currently Chairperson of the TTSH ERAS® program. Dr How is also program director for the Surgery-In-General Program, deputy director of the endoscopy unit in his hospital and president elect of the Society of Parenteral and Enteral Nutrition (Singapore). ### Valérie Addor (Switzerland) Valérie Addor works at the Department for Visceral Surgery at the University Hospital CHUV in Lausanne, Switzerland. She has been involved in ERAS® since 2011. As an ERAS dedicated nurse and coach, her main interests are multidisciplinary work and nursing workload. She has trained nearly 60 teams from different specialities, in Europe, Latin America, USA and India. ### Ms Angie Balfour (UK) Angie Balfour has been involved in ERAS® for over 15 years as the lead ERAS Nurse and Senior Research Nurse in Edinburgh, Scotland. She is also the chair of the ERAS® Nursing & AHP section of the ERAS® Society. Her main interests include education and training both for staff but also for patients about the benefits of ERAS®. She is also very interested in research within the nursing profession, specifically examining common themes and nurses perceptions about ERAS® and how we can improve the overall understanding of why the surgical process is ever-changing. ### Mr Matthew Perry (UK) Matthew was appointed as a Consultant Urological Surgeon to St George's Hospital in 2005. He was invited to set up the robotic cystectomy service at The Royal Surrey Hospital, Guildford in 2013 and moved his practice to Guildford in 2016. Matthew, a Londoner, went to Charing Cross and Westminster Medical School before qualifying in 1993. He gained his MD for research into Cancer Vaccines for prostate cancer in 2002. He is a pelvic cancer specialist, providing surgical services for complex pelvic cancer. He specialises in Robotic surgery for the treatment of prostate and bladder cancer. He introduced the robotic cystectomy programme with enhanced recovery processes enabling safer surgery with a shorter length of stay and lower complication rate at both St George's and the Royal Surrey Hospitals. Matthew is Clinical Director for Urology services at the Royal Surrey, he is an adviser to Cancer Research UK charity and a Trustee of the Prostate Project charity. ### Professor Mike Scott (USA) Mike is currently Division Chief Surgical & Neuroscience Critical Care Medicine, Medical Director PENN E-LERT, Department of Anesthesiology and Critical Care Medicine at the University of Pennsylvania School of Medicine. Mike undertook his undergraduate medical training in the UK and Postgraduate training in the UK and Australia. He trained in internal medicine before doing anesthesiology and critical care medicine and has Fellowships with the Royal College of Physician’s, Royal College of Anaesthetists and Faculty for Intensive Care Medicine. Mike moved to the USA from the UK at the end of 2016 to take up a clinical position and Professor in anaesthesia and intensive care medicine at VCU, Richmond, VA. He is currently Division Chief Surgical & Neuroscience Critical Care Medicine, Medical Director PENN E-LERT, Department of Anesthesiology and Critical Care Medicine at the University of Pennsylvania School of Medicine. Mike is co-author for some of the ERAS® Society Consensus Guidelines, Chair of the ERAS® Education Committee and sits is on the ERAS® Society Executive Committee. He was a member of the WHO Education Committee and Member and author of the World Health Organisation LIFEBOX Project Pulse Oximetry Manual and algorithms. ### Professor Timothy Rockall (UK) Professor Rockall is a Consultant Surgeon at The Royal Surrey County Hospital, Guildford and Professor of Surgery at Surrey University, UK He specialises in laparoscopic gastrointestinal surgery and has a particular interest and expertise in laparoscopic colorectal surgery. He was previously Senior Lecturer at Imperial College, London in the department of Surgical Technology and Oncology and Honorary Consultant at St. Mary’s Hospital London, where he directed the clinical robotics programme. He has held the position of Director of the Minimal Access Therapy Unit (mattu) in Guildford since 2003. The mattu convenes multiple educational courses in multiple disciplines but with an emphasis on laparoscopic surgery and was a training centre for the National Laparoscopic Colorectal Training programme (LAPCO). He has an active research programme in the fields of Minimally Invasive Surgery, Enhanced Recovery, Prehabilitation and Imaging technology. He is Past President of The Association of Laparoscopic Surgeons of Great Britain and Ireland and is currently a member of Council of the Royal College of Surgeons of England. ### Professor Olle Ljungqvist (Sweden) Olle Ljungqvist is a professor of Surgery at Örebro University and KarolinskaInstitutet Sweden He co-founded the ERAS® Society and served as the Chairman of its Executive Committee until July 2022. He invented the idea of preoperative oral carbohydrates instead of fasting before elective surgery and has published more than 300 original papers, book chapters and reviews on surgical nutrition, surgical metabolism, surgical stress, and ERAS. Olle Ljungqvist MD, PhD received his medical degree and obtained his PhD on glucose metabolism in hemorrhage at the Karolinska Institutet in Sweden. He completed his residency and held several clinical positions in gastrointestinal surgery at the Karolinska Hospital and was appointed Professor of Surgery Nutrition and Metabolism in 2005 at the Karolinska Insitutet. He chaired the Center for Gastrointestinal Disease at Ersta hospital 1999-2008, Stockholm before taking up his current position as Professor of Surgery at Örebro University, Sweden in 2009. Dr Ljungqvist has served as Chair of the European Society for Clinical Nutrition (ESPEN), the International Association for Surgical Metabolism and Nutrition (IASMEN) as part of the International Surgical Society. He co-founded the Enhanced Recovery After Surgery (ERAS®) Society 2010 and served as the Executive Chairman until 2022. The ERAS® Society has initiated and runs a world wide implementation program of evidence based perioperative care reaching 26 countries on every continent. This program has shown to reduce complications and hospital stay by 30-50%, is associated with a 40% improved five year survival and substantial cost savings in major colorectal cancer surgery. Olle Ljungqvist also proposed the use of preoperative carbohydrates instead of overnight fasting for elective surgery, a treatment that is currently guideline recommend world-wide. His research interests are surgical stress, metabolism and nutrition and outcomes focusing on ERAS, publishing more than 200 original contributions, international guidelines, book chapters and reviews. He has co-edited several international textbooks on Clinical Nutrition and on ERAS. He is invited to deliver about 20 international main lectures worldwide annually. Honorary member of ESPEN 2017, Tedx speaker 2017. ### Dr Hans D de Boer (Netherlands) ### Professor Dileep Lobo (UK) Dileep N Lobo is Professor of Gastrointestinal Surgery and Consultant Hepatopancreaticobiliary Surgeon at Nottingham University Hospitals, UK. Dileep N Lobo, MB BS, MS, DM, FRCS, FACS, FRCPE is Professor of Gastrointestinal Surgery and Consultant Hepatopancreaticobiliary Surgeon at Nottingham University Hospitals. He was awarded a DM degree with distinction by the University of Nottingham for his work on fluid and electrolytes and is a recipient of the Sir David Cuthbertson Medal and the Hunterian Professorship for his contributions to the field of Nutrition and Metabolism. He has been awarded the prestigious James IV Society of Surgeons Traveller’s Award and the Moynihan Fellowship. His clinical interests focus surgery of the pancreas and biliary tree. His research interests include surgical nutrition and metabolism, fluid and electrolyte balance and pancreatic cancer. He is currently Associate Editor of Clinical Nutrition and has been Clinical Editor of Surgery (Oxford) and Associate Editor of the European Journal of Clinical Nutrition. He is Chair of the Scientific Committees of the ERAS® Society and the European Society for Clinical Nutrition and Metabolism. He was Honorary Secretary of the Society of Academic and Research Surgery and President of the International Association for Surgical Metabolism and Nutrition.   ## Specialties ### Cytoreductive surgery Coming Soon ### Vascular Vascular disease encompasses a wide range of disease processes. The common forms of vascular disease include aneurysmal or occlusive disease of arteries or veins in the neck, chest, abdomen and/or the extremities. Vascular pathology can be acute or chronic. In both acute and chronic cases, vascular disease can be limb or life threatening and both the disease and treatments can significantly impact a patient’s quality of life. Vascular patients frequently require complex case plans since they are typically elderly, frail and have multiple co-morbidities when compared to the general population. Patients undergoing procedures for vascular disease are at high risk for complications in the postoperative period, prolonged hospitalization and increase resource utilization.1 Since the tenets of enhanced recovery after surgery (ERAS) are to deliver high-quality perioperative care and accelerate recovery, reducing the need for healthcare resources and improving patient satisfaction, it is an ideal framework to improve the perioperative outcomes for a high-risk population like patients with vascular disease undergoing surgery. Although ERAS protocols have gained significant popularity in specialties such as colorectal and orthopedic surgery, ERAS has not been widely accepted or adopted in vascular surgery. A review of current ERAS programs by McGinigle et al. demonstrated that the use of ERAS pathways in vascular surgery is limited and the evidence is at best moderate in aortic surgery and poor to absent other commonly performed procedures such as open and endovascular treatment of peripheral arterial disease.2 Although there is evidence to support advantages such as decreased length of stay for vascular surgery patients following implementation of ERAS, the authors acknowledged that further research is required to evaluate the effectiveness and appropriateness of ERAS in the vascular surgery population. In 2022, the Enhanced Recovery After Surgery (ERAS) Society and Society for Vascular Surgery published a consensus statement on the use of enhanced recovery for patients undergoing open aortic vascular surgery. In this expert consensus review for implementation of ERAS after aortic surgery, there are 36 recommendations organized into preadmission, preoperative, intraoperative, and postoperative recommendations. Consensus recommendations for the implementation of ERAS after lower extremity arterial bypass are also forthcoming. We anticipate that these expert consensus documents will help support the acceptance and increase the application of ERAS following vascular surgery procedures. In the interim, it is our goal to advocate for the adoption of ERAS in vascular surgery and to provide vascular teams with the tools necessary for successful implementation. References 1. Brooke BS , De Martino RR, Girotti M, Dimick JB, Goodney PP. Developing strategies for predicting and preventing readmissions in vascular surgery. J Vasc Surg. 2012 Aug;56(2):556-62. 2. McGinigle KL, Eldrup-Jorgensen J, McCall R, Freeman NL, Pascarella L, Farber MA, Marston WA, Crowner JR. A systematic review of enhanced recovery after surgery for vascular operations. J Vasc Surg. 2019 Aug;79(2): 629-640. ### Breast Breast cancer is one of the most common cancers diagnosed in women1,2.  Breast reconstruction has been identified as a gold standard for women undergoing breast cancer treatment as it has demonstrated improvements in satisfaction and quality of life3-5.  Given the ongoing stress to the global health care systems, two main goals of health care include providing the best quality of patient care while optimizing health care costs and expenditures.  Therefore, Enhanced Recovery After Surgery (ERAS) protocols have received growing attention due to providing improvement in patient outcomes while documenting health care savings.  Although ERAS protocols gained initial popularity in alternate surgical specialties, these protocols are gaining recognition and acceptance in breast surgery and specifically breast reconstruction surgery.   The first landmark ERAS study with breast reconstruction patients focused on autologous, or microvascular and free flap, breast reconstruction6.  This study demonstrated significantly decreased opioid consumption and length of hospital stay without any differences in complications versus traditional postoperative pathways.  In 2017, the ERAS Society published its consensus recommendations for an ERAS protocol specific to breast reconstruction surgery7.  The published ERAS protocol consists of 18 key recommendations, of which the key tenets include: multimodal analgesia and reduction of opioid consumption, use of anesthesia to decrease postoperative nausea and vomiting and pain, minimal preoperative fasting and early feeding, and early postoperative mobilization7.   Since the publication and dissemination of the ERAS guidelines for breast reconstruction, multiple studies have shown significant reductions in opioid consumption and length of hospital stay for both implant-based breast reconstruction8-11 and autologous breast reconstruction12-15.  The combination of these key findings have led to improvements in the patient experience and significant health care savings16.   Although the consensus recommendations for an ERAS protocol specific to breast reconstruction7 and associated postoperative order sets for these ERAS pathways17 have been available since 2017, there is still incomplete implementation of ERAS protocols for breast reconstruction surgery14,18.  Therefore, our goal is to continue to advocate for adoption of ERAS protocols amongst surgeons performing breast reconstruction while providing the necessary tools and education to make the adoption of ERAS protocols feasible for surgeons. ### Upper GI Coming Soon ### Emergency Surgery Coming Soon ### Neonatal / Paediatric ### Urology The ERAS® Society – Urology Chapter was officially formed at the 2016 World Congress in Lisbon. The group was chaired by Dr Yannick Cerantola (Switzerland) until 2018 and is now chaired by Dr Sia Daneshmand (USA).   With over 500,000 new diagnoses each year and 200,000 deaths, bladder cancer (BC) is one of the most common and lethal malignancies worldwide [1]. A quarter of all cases are muscle invasive with significant risk of mortality. While less lethal, non-muscle invasive disease has a risk for recurrence and progression [2, 3]. These risks are greatest in patients with T1 disease, high-grade disease after failure of intravesical therapy and in certain variant histologies [4]. The management of BC is therefore aggressive with radical cystectomy (RC), pelvic lymphadenectomy and urinary diversion considered standard of care for muscle invasive disease, certain high-risk non-muscle invasive diseases and after failure of intravesical or trimodal therapy [4-6].   While RC leads to improved long-term survival, the operation is one of the most complex urological operations with risk of perioperative morbidity. Postoperative length of stay (LOS) has been reported up to 17 days in European studies and up to 9 days in US registry studies [7, 8]. Complications occur in up to 60% of patients and readmissions in 30% [9]. The adoption by urologists of enhanced recovery after surgery (ERAS) protocols has dramatically improved the perioperative care of patients undergoing RC [10, 11]. These protocols include preoperative, intraoperative, and postoperative modifications to enhance recovery and reduce stress following surgery. In 2013, the ERAS Society published guidelines for perioperative care after radical cystectomy [12]. Since the publication of these guidelines and initial implementation of ERAS protocols, evidence supporting the use of ERAS after radical cystectomy has grown.   Acceptance of and adherence to these protocols will continue to improve with refinement of existing interventions and development of new ones. Current work focuses on improving outcomes beyond the index hospitalization and includes efforts to decrease late complications, readmissions, costs and the overall patient experience. ### Thoracic ### Anaesthesia ### Bariatric ### Cardiac ### Colorectal ### Obstetrics & Gynaecology ### Head & Neck ### HPB ### Nursing & AHPs ### Orthopaedics   Current status The first orthopaedic surgeries to use enhanced recovery pathways were total hip arthroplasty (THA) and total knee arthroplasty (TKA).  These procedures were chosen as they were high volume, had long hospital length of stays, and carried high costs. Enhanced recovery pathways were first widely adopted in countries such as Denmark and the United Kingdom (UK) through the use of centrally organised improvement programs. Their success led to international spread, and enhanced recovery is now broadly accepted as best practice for hip and knee arthroplasty surgeries.   Enhanced recovery pathways aim to reduce a patient’s recovery time following surgery, and improve patient outcomes. To do this, orthopaedic enhanced recovery pathways encourage the patient to be active in the process of their recovery. Multi-disciplinary teams focus on combining the evidence-based clinical steps with the required process and system changes, so that care is consistent for each patient.  Logistical processes as well as clinical steps are optimised for each patient, so that post-operative recovery is quickened, and complications, adverse events and morbidity are reduced.   The over-arching principles of an orthopaedic ERAS pathway can be divided into four stages.  At the pre-operative stage the focus is on optimisation of pre-operative physical and psychological, such as the identification and management of anaemia, and use of pre-operative education and counselling. Additionally, pre-emptive organisation of discharge arrangements is important. Intra-operatively, atraumatic surgical techniques are used; anaesthesia and analgesia protocols are standardised, multimodal opioid sparing analgesia regimes are adopted; blood loss is spared; normovolemia and normothermia are promoted, and hypoxia prevented. Post-operatively, early ambulation with effective analgesia is essential (avoiding opioids where feasible); catheters, drains and drips are not used or removed as soon as possible; and patients are encouraged to eat and drink early, and wash, dress and socialise as soon as possible.  All patients are discharged home, using agreed criteria managed by the multi-disciplinary team; with clear instructions and support on progressing independently.   ERAS pathways have been so successful in reducing length of stay that there is now a growing trend and evidence for outpatient surgery for THA and TKA. Currently, outpatient arthroplasty can be a safe and effective procedure for carefully selected patients, however more research is required in order to critically examine its safety and potential cost-savings for all patients.     Future directions Whilst outcomes have improved dramatically in the last ten years, challenges remain in order to achieve widespread adoption and implementation of what is already known, and there are future research challenges in order to improve our understanding of the pathophysiology of factors effecting recovery, such as the inflammatory response and pain, and the most effective rehabilitation regimes. The ERAS Society Guidelines, in both hip and knee, and also lumbar spine fusion, will hopefully help to bridge both the implementation gap for those new to enhanced recovery, and help to consolidate the current heterogeneous evidence base, where direct comparison of enhanced recovery components is difficult with so many differences in the pathways currently used.   In addition, the application and development of enhanced recovery in other elective and emergency orthopaedic procedures (such as hip fracture and shoulder arthroplasty) is an exciting and emerging area that looks set to bring the benefits of enhanced recovery to even more orthopaedic patients. ## Events ### Annual meeting of the Taiwan ERAS Chapter: online ### 11th ERAS World Congress, September 17-19th 2025, Turin, Italy. The ERAS® Society is delighted to announce that its 2025 Congress will be held from September 17th- 19th in the Lingotto Conference Centre, Turin. This iconic building once housed the Fiat car factory. Turin is a wonderful city of culture and cuisine in Northern Italy, and well served by air, road and rail. We are partnering with Professor Luca Gianotti from Università degli Studi di Milano-Bicocca. The programme will include: • The ERAS Educational Course (day one) • Two full days of lectures, interactive sessions. There are three keynote lectures and throughout leading clinicians and academics will present on all aspects of ERAS® physiology and pathophysiology, including surgery, anaesthesia and perioperative medicine, nursing, allied health and patient experience. We will cover established areas, debate new advances and look at the role of AI, robots and databases in improving patient care and outcome. We will discuss various aspects of implementing ERAS® in high, middle and low income countries. We will explore how our guidelines have shaped ERAS® practice. • Abstract submission. All accepted abstracts will be published in Clinical Nutrition ESPEN, with the best abstracts considered for cash prizes. Do join us for a historic meeting as we celebrate 30 years since ERAS concepts were first published, and 20 years since our first guidelines were produced!   ** Keynote Speakers Confirmed**   Delivering ERAS in a wartime setting. Professor Ivan Lisnyy, Ukraine.   Artificial Intelligence for Surgical Patients. Professor Elena Giovanna Bignami, Italy.   The changing landscapes of managing and detecting postoperative complications. Professor Michael Scott, USA.   ### 4th ERAS Asia-Pacific International Congress "Improving Patient Care Through ERAS in Asia-Pacific" The 4th ERAS Asia-Pacific Congress held in Manila on November 14-15, 2024, was a landmark event in the realm of surgical care in the region, highlighting the significance of the Enhanced Recovery After Surgery (ERAS) protocol. Co-presented by The Medical City (TMC), the congress brought together over 270 healthcare professionals from 11 countries to delve into cutting-edge advancements in ERAS. This biennial congress underscored the growing international interest in optimizing surgical outcomes and recovery, especially with the leadership of TMC as the ERAS®Center of Excellence in the Philippines and a key driver in promoting ERAS standards across various surgical disciplines.   (From left to right; Dr. Alexandra Nina Odi (Congress Co-chair,) Dr. Eugene Ramos, (Past Group CEO and President of The Medical City), Dr. Gerardo Legaspi (Director of UP-PGH), Dr. Marianna Ramona Sioson (Congress Overall Chair)   The event featured insightful discussions on: Optimizing Preoperative Care: Experts discussed strategies to better prepare patients before surgery, including nutritional interventions, psychological support, and medication management. Minimizing Intraoperative Stress: There were key presentations on strategies to reduce surgical trauma and streamline procedures, ensuring smoother surgeries and reduced complications. Accelerating Postoperative Recovery: Evidence-based methods were presented to enhance recovery post-surgery, focusing on minimizing pain, reducing recovery times, and preventing common postoperative complications. Implementing ERAS in Diverse Settings: One of the major themes of the congress was overcoming the challenges of applying ERAS protocols in varied healthcare environments. Experts shared best practices and solutions for adapting ERAS to resource-limited settings and diverse healthcare systems. (From left to right: Shukri Jahit (Malaysia), Shu Lin Guo (ERAS® Taiwan),  How Kwang Yeong (ERAS® Society International), Kyoichi Takaori (ERAS® Japan), Kylie Sandy-Hodgetts (Australia), Marianna Ramona Sioson (TMC POM-ERAS & ERAS® Philippines), Cristine Obra (UK), Dr. Medhat Shalabi (PAME-ERAS)   Additionally, the congress emphasized the importance of data-driven quality improvement. By systematically collecting and analyzing patient data, healthcare providers can identify areas for improvement within their practices and fine-tune ERAS protocols to consistently achieve optimal patient outcomes. Beyond advancing surgical care, the 4th ERAS Asia-Pacific Congress also demonstrated a strong commitment to social responsibility. This was exemplified by support for the Adopt-A-Patient Program of the Akbay Ginhawa Foundation Inc., which helps provide care for patients in need. Through this initiative, the congress reinforced its dedication not only to advancing healthcare but also to ensuring that those who are less fortunate receive the support they require. Looking ahead, the 5th ERAS Asia-Pacific Congress was announced by How Kwang Yeong, executive member of the ERAS® Society, and is set to be held in Singapore in 2026. As the ERAS movement continues to gain momentum, it is clear that this innovative, multidisciplinary approach will play a pivotal role in shaping the future of surgical care. By improving patient outcomes and enhancing the overall quality of healthcare, ERAS is poised to become a cornerstone of modern medical practices across the Asia-Pacific region and beyond.         4th ERAS ASIA-PACIFIC 2024 CONGRESS WORKING COMMITTEES Marianna Ramona Sioson, MD Overall Chair Alexandra Nina Odi, MD Co-chair Scientific Programme Marianna Ramona Sioson, MD. Alexandra Nina Odi, MD. Florianne España, MD. Zarinah Gonzaga, MD. How Kwang Yeong (International Adviser). Angela Felice Sioson (Assistant) Abstract Presentations Nathalia Montemayor, MD. Zarinah Gonzaga, MD. Carla Sibug, RN Ways and Means Marie Dione Sacdalan, MD. Maria Dolma Gudez-Santos, MD. Marianna Ramona Sioson, MD Physical Arrangement Carlo Cajucom, MD. Angelo Leaño, MD. Nadja Trinchera (Yellow Bird Tours) Registration and Housing Bureau Marie Jaymee Sanchez, RN. Kate Camille Lacap, RN. Nadja Trinchera (Yellow Bird Tours) Socials Maria Christina Reyes, MD. Caroline Hernandez, RND. Pauline Vizcarra, RND Publicity and Microsite Marinela Aya Narciso (TMC Marketing) Secretariat Nadja Trinchera (Yellow Bird Tours)   ### 10th ERAS World Congress September 18-20th 2024, Malaga, Spain. The 10th ERAS® World Congress was held between 18th  – 20th September 2024, at the Hotel IPV Palace Malaga, Spain. The congress was jointly organised by the ERAS Society and Luis Sanchez-Guillen from the  Spanish organising committee: the Spanish Multimodal Rehabilitation Group (GERM). As in previous years, it consisted of the ERAS® Educational Course on the Wednesday followed by the Scientific Programme on Thursday and Friday. Throughout the Congress, they were many excellent lectures from experts from around the world. The ERAS® educational course was again a hugely popular event, and with the delegates learning about the relevant physiology underpinning the concepts of ERAS®. Similar to last year it was condensed into a morning course, allowing time to have a number of different break out specialty meetings in the afternoon. Which consisted of the nursing, ANP & AHP group (including a separate French nurses meeting), Obstetrics and Gynaecology, Paediatrics, Cardiac, Urology group meetings. All of which were hugely popular and provided a great opportunity for different groups to discuss the various issues around their different specialities. This was followed by a highly enjoyable drinks reception, where everyone was able to network, view posters and meet with our sponsors. The Main Scientific Programme started the next day, with an excellent session devoted to how we can improve standards in ERAS research. The talks focused on trial design, including pragmatic RCTs, large database studies and how AI may help perioperative research. The prestigious Ken Fearon lecture was given by our very own Chair of the Scientific Committee Professor Dileep Lobo. He neatly summarised his twenty-five year experience and learning of intravenous fluids.     This was followed by ERAS advances in key specialities session on breast, colorectal, bariatric and urology surgery. The afternoon session started off with the first of two innovative sessions – Avoiding pitfalls in research and secondly  - discrimination, equality, diversity and inclusivity in healthcare. The day closed with some special topics (obstructive sleep apnoea, shared decision making and consent and ERAS in LMICs) and  the always popular best abstract presentations and rapid fire presentations. The second day of the Congress began with an expert panel discussion on when ERAS goes wrong. Followed by the Olle Ljungqvist Lecture, where Mehul Raval gave a fascinating lecture on the Environmental impact of Surgery.       The morning session continued with sessions on basic sciences (muscle-targeted interventions for sarcopenia, modulation of gut microbiota and short bowel syndrome) and important talks about how to improve outcomes in perioperative care. The afternoon session started with Henrik Kehlet lecture.  Steven Wexner gave a fascinating talk on the value of standards in optimising outcomes. Fortunately Henrik Kehlet was on hand to present him with his award plaque.         Another innovative session followed, with an interview of two titans of the Enhanced Recovery world – the mastermind behind Fast-Track surgery Professor Henrik Kehlet and co-founder of the ERAS Society Professor Olle Ljungqvist. The final session was on current controversies: post-operative insulin resistance, diabetes and obesity and prehabilitation. Award winners: Best nurse and Allied Health Professional Presentation: Adeline Chi – “A Singapore Study: The outcomes of fast-track nurse-led mobilisation in elective colorectal patients”.   Best e-poster of distinction: Erin Barrett – “Early urinary catheter removal after lumbar fusion surgery – a quality improvement initiative”.   Best rapid fire presentation: Shannon Crotwell – “Enhancing recovery after cardiac surgery: automated element auditing” Best oral presentation: Marco Catarci – “Bowel preparationfor elective colorectal resection: Multi-treatment machine learning analysis on 6,241 cases from the perspective iCral cohort”. There were many highlights of the Congress. The Henrik Kehlet,  Ken Fearon  and Olle Ljungqvist Lectures were all outstanding and thought provoking in equal measure. The new innovative sessions on equality, diversity and inclusivity, pitfalls in research and improving standards in research were also particularly well received. The popularity of the congress continues to grow, with 421 delegates attending, and importantly representation from 41 different countries (including 2 from war-torn Ukraine). We had 144 accepted abstracts presented as posters oral presentations and for the first time 30 e-posters of distinction. It is always exciting to see so many new people present their work , which was a very high standard this year. It is these talented researchers that will grow the evidence base which underpins the future success of ERAS®. The huge success of the Congress is made possible only by the hard work of the Organising Committee and the Local Committee, to whom we express our sincere gratitude. In addition, we are most grateful to the sponsorship we receive from industry and the expert assistance from PRRI. We would also like to mention the outgoing Scientific Chair Professor Dileep Lobo who has done an amazing job of each and every one of the last 10 World Congresses. On behalf of the ERAS Executive Committee thank you again Dileep for all your hard work. The 11th ERAS® World Congress is already being planned for, and the location will be announced soon and we look forward to welcoming you and your teams there!               ### 2023 Australia-Asia-Pacific ERAS+ conference We are delighted to advertise the Australia-Asia-Pacific ERAS+ conference from 26-29 October 2023 at the Park Hyatt Hotel in Melbourne, Australia. The meeting combines two meetings into one: Prehabilitation and ERAS. The first one and a half days will be dedicated toward prehabilitation (addressing patient-related modifiable risk), and the second one and a half days will be dedicated toward ERAS (reducing variability in clinical care), thereby forming the interdependent ERAS+ that strives to improve patient outcomes after surgery. This easily accessible meeting aims to provide shared learning across this region of the world, with opportunity for interaction with perioperative clinicians, including anaesthetists, surgeons, nurses, and allied health practitioners from Australia and Asia-Pacific countries, and to leverage international expertise in prehabilitation and ERAS from Canada, Europe, and the United Kingdom. The program will be interactive: plenary lectures, pro/con debates, and breakout sessions. The meeting will also host three Master Class Workshops on Thursday (26 October) morning before the conference. These include a primer workshop in cardiopulmonary exercise testing, an ERAS educational course, and a wound healing workshop. The program hosts several prominent speakers, including: International experts in prehabilitation: Professor Mike Grocott, Professor Sandy Jack (UK), Dr John Moore, and A/Professor Malcolm West (UK), and Professor Ismail Gögenur (Denmark), and Professor Bernhard Riedel, Professor Linda Denehy, Dr Ianthe Boden, A/Professor Nicole Kiss, A/Prof Daniel Steffens and Dr Hilmy Ismail (Australia). International experts in ERAS: Dr Hans de Boer (ERAS President, Holland), Professor Ketan Dhatariya (UK), Dr Kwang Yeong How and Dr Vera Lim (Singapore), Professor Olle Ljunqvist (Sweden), Professor Greg Nelson (Canada), Ms Catherine Sinton and Dr Georgina Christelis (Australia) Expertise from Asia-Pacific: Professor Aoyama (Japan), Dr Shu Lin Guo (Taiwan), Professor Verut Lohsiriwat (Thailand), and Dr Marriana Sioson (Philippines). Australian Surgical Expertise in Value-Based Health Care: Professor David Watters from Safer Care Victoria, Professor Christobel Saunders, AO, James Stuart Chair of Surgery, University of Melbourne. State government and hospital executive expertise: Ms Ellen Rawstron (NSW), Professor Ben Thomson and Ms Naomi Bromley (Vic), and Professor Shelley Dolan (Hospital Executive). Frontline Clinicians (allied health, medical, nursing): Who are willing to share their expertise on implementing and delivering high-quality Prehabilitation and ERAS Local convenors: Professor Bernhard Riedel Dr Hilmy Ismail and Professor Linda Denehy (Prehabilitation) Dr Georgina Christelis (ERAS). In association with: International Prehabilitation Society® ERAS Society® Peter MacCallum Cancer Centre ### 7th World ERAS Congress 1-3rd May 2019 Liverpool - Programme ### Euroanaesthesia 2023 3rd -5th June Glasgow We are delighted to help advertise Euroanaesthesia 2023, Europe’s landmark meeting on anaesthesia, intensive care, pain, perioperative medicine, and critical emergency medicine. Which will be held in the beautiful city of Glasgow. ### 9th ERAS World Congress May 31st - June 2nd 2023 in Lisbon Portugal The 9th ERAS® World Congress was held between 31st May – 2nd  June 2023, at the Hotel Marriott, Lisbon, Portugal ERAS Society Chairman - Dr Hans de Boer giving the welcome address. The congress was jointly organised by the ERAS Society and Prof Rui Maio, Clinical Director (Catedrático de Cirurgia da FCM-NMS) of Hospital da Luz Arrabida and ERAS Center. As in previous years, it consisted of the ERAS® Course followed by the Scientific Programme. Throughout the Congress, they were many excellent lectures from experts from around the world. The ERAS® educational course was again a hugely popular event, and with the delegates learning about the relevant physiology underpinning the concepts of ERAS®. This year it was condensed into a morning course. This allowed time to have a number of different break out specialty meetings. Which consisted of the nursing, ANP & AHP group (including a separate French nurses meeting), Obstetrics and Gynaecology, Paediatrics, Cardiac, Urology and Orthopaedic/Spine, and Vascular group meetings. Furthermore, the new installed LMIC Committee of the ERAS Society announced their ambitious plans to have ERAS available in LMIC. All of which were hugely popular and provided a great opportunity for different groups to discuss the various issues around their different specialities. This was followed by a highly enjoyable drinks reception, where everyone was able to network, view posters and meet with our sponsors. A packed conference room for the popular nursing ANP & AHP group.   The Main Scientific Programme started the next day, with a session devoted to problem solving issues around the ‘problem’ patient and how ERAS might be able to help. (This included preoperative preparation of the patient with inflammatory bowel disease, intestinal failure and diabetes) The prestigious Henrik Kehlet Lecture by Professor Bernadette Kumar from Norway, entitled Inequalities in Global Health. Prof Kumar is a Public Health Epidemiologist with over 30 years of global health experience. Giving a fascinating insight into the many inequalities that exist within health care today. Whilst enforcing the global health priorities – the 3 C’s. Climate change, COVID and Conflict (of particular importance as we had a delegate from war torn Ukraine). Professor Bernadette Kumar being congratulated by Professors Henrik Kehlet and Dileep Lobo.   This was followed by ERAS advances in key specialities session on emergency laparotomy, obstetrics and gynaecology, HPB, paediatrics and cardiac. The afternoon session started off with an interesting session on current controversies including large trials in fluid therapy – are there problems? Prehabilitation for all or some? And finally prolonged VTE prophylaxis. The day closed with the always popular best abstract presentations and rapid fire presentations. The second day of the Congress began with a debate whether opioid free analgesia and anaesthesia is the way forward. Followed by the inaugural Olle Ljungqvist Lecture. Fittingly it was given by Olle’s long-term friend and colleague Professor Arthur Revhaug a fellow surgeon from Norway. Professor Arthur Revhaug receiving his commemorative plaque from Chairman Dr Hans de Boer   The morning session continued with sessions on basic sciences and important talks about how to get engagement from management. The afternoon session started with Ken Fearon lecture, in memory Co-founder and Chairman of the ERAS Society Board.  A truly fascinating talk was given by Dr Jugdeep Dhesi on how a geriatrician can influence surgical recovery. Which included invaluable strategies on how to manage frailty and postoperative delirium. Professors Olle Ljungqvist and Bill Fawcett congratulating Dr Jugdeep Dhesi  The final sessions were on health literacy and outcomes of meaning for patients, separate sessions on the role of the nurse, dietician and physiotherapist in a successful ERAS pathway. Then finally on regional anaesthesia and ERAS: are epidurals obsolete?, TAP blocks and regional anaesthesia for limb surgery. The Congress concluded with our Scientific Chairman Professor Dileep Lobo awarding prizes to Bayley Jones wining the nursing ANP & AHP Abstract Prize with a talk entitled “Preoperative education is associated with adherence to individual components of enhanced recovery”. The poster of distinction prize was won by Prof Marco Catarci from Italy. The rapid fire presentation was won by Tyler McKechnie  from Canada. A systematic review and meta-analysis”; with the runner up Allyson Cochran from the United States. The best presentation prize was won by Rico Wiesenberger from Germany and the runner up prize was awarded to Marta Sandini from Italy, see below for more details: Poster Prize winner: Marco Catarci: Does an enhanced recovery pathway influence major outcomes after colorectal surgery? Prof Marco Catarci receiving his prize from Dr Hans de Boer Rapid fire presentations: Winner  – Tyler McKechnie: Enhanced Recovery After Surgery Protocols Following Emergency Intra-Abdominal Surgery: A Systematic Review and Meta-Analysis Runner up – Allyson Cochrane: ERAS Recommendations that Most Impact Care: A Multi-Institutional, Multi-Discipline Analysis in the United States Allyson Cochrane receiving her runner-up prize of the ERAS textbook from Dr Hans de Boer   Best abstract: Winner  – Rico Wiesenberger: Influence of Motivational Interviewing on postoperative mobilization in the ERAS®-Pathway in elective bowel surgery - a randomized blinded pilot study Runner up – Marta Sandini: Parenteral nutrition use in digestive surgical patients mismatches actual food intake: Analysis from nutrition Day 2016-2021 There were many highlights of the Congress. Certainly, the Henrik Kehlet,  Ken Fearon  and new Olle Ljungqvist Lectures were all outstanding and thought provoking in equal measure. The popularity of the congress continues to grow, with almost 500 delegates attending, and importantly representation from 41 different countries! We also had 143 accepted abstracts presented as posters and oral presentations. It is always exciting to see so many new people present their work , which was a very high standard this year. It is these talented researchers that will grow the evidence base which underpins the future success of ERAS®. The huge success of the Congress is made possible only by the hard work of the Organising Committee and the Local Committee, to whom we express our sincere gratitude. In addition, we are most grateful to the sponsorship we receive from industry and the expert assistance from PRRI. The 10th ERAS® World Congress is already being planned for, and the location will be announced soon and we look forward to welcoming you and your teams there!   For those who were successful in getting abstracts accepted, they have been published by Clinical Nutrition - ESPEN here. ### Swedish ERAS Society National Meeting 17-18th November 2022 We are delighted to announce the Annual meeting for the Swedish Chapter of the ERAS Society, which will be held on 17-18th November in Stockholm. There are a number of talks including from our very own Angie Balfour and Gregg Nelson. For more information click here. ### Euroanaesthesia 2022 4-6th June in Milan There is still a chance to register for the Euroanaesthesia 2022 Congress in Milan, but please note that registration closes on the 22nd May. Click here for more details and to register. ### International Surgical Week, the World's Congress of Surgery 15-18th August 2022 We are pleased to help promote the upcoming International Surgical Week ISW 2022 - 49th World Congress of the International Society of Surgery ISS/SIC, which will take place on 15 to 18 August 2022 in Vienna, Austria. The ISW 2022aims to provide a platform for scientific and clinical working groups where they can collaborate to establish the foundations for future diagnostic and surgical challenges, and discuss novel approaches and standards, facilitating progress towards real-time, patient-oriented solutions. Click here for more information. ### Asia Partnerships In ERAS® Forum November 2021 ### ERAS 2022 Congress in Madrid ### ERAS USA 4th Annual Congress on the 10th–12th of November 2021 ERAS USA's mission is to develop perioperative care and enhance postoperative recovery through research, audit, education, and implementation of evidence-based practice. Central to this mission is a culture of inclusivity and recognition of the importance of multi-professional and multi-disciplinary collaboration. We encourage our Congress attendees - surgeons, anesthesiologists, advanced practice providers, nurses, researchers, health care administrators - to participate and interact in all sessions as it takes the entire care team to make ERAS successful! ### ERAS® SOCIETY 10TH ANNIVERSARY WORLD DAY – 14TH NOV 2020 Thank you to all faculty and attendees who participated in the ERAS USA virtual program, ERAS Updates and Future Directions, on November 14, 2020! CME and CEU credits are available to registrants who participated in the live event. ERAS USA like to acknowledge its industry partners Cardinal Health and Edwards Lifesciences for their participation in this event. Please be sure to save the date and plan to attend the 2021 ERAS USA and ERAS Society Joint Congress July 7-9, 2021! ### NOW ONLINE: THE ERAS AND COVID-19 GLOBAL SEMINAR ### 11th September - Emergency laparotomy ### Welcome to join the SwERAS congress SwERAS-dagarna the 18th–19th of November 2021 The Swedish ERAS Society SwERAS is pleased to announce the annual congress back again as a live event in November in Stockholm. ### Turkish ERAS Society June 11-13, 2021 Please join our Turkish colleagues who are running the 2nd Congress of the Turkish ERAS Society June 11-13, 2021. ### The 1st World Congress of ERAS®, Cannes, France, 2012 ### The 2nd World Congress of ERAS®, Valencia, Spain, 2014 ### The 3rd World Congress of ERAS®, Washington, U.S.A., 2015 ### The 4th World Congress of ERAS®, Lisbon, Portugal, 2016 ### The 5th World Congress of ERAS, Lyon, France, 2017 ### The 6th World Congress of ERAS, Stockholm, Sweden, 2018 ### Programme - 2018 Congress Stockholm ### ERAS Congress 2017 ### Other upcoming ERAS Events ### Webinar Series ### ERAS Implementation Webinar ### Perioperative opioids and ERAS ## Expert Reviews ### Early postoperative ERAS compliance predicts decreased length of stay and complications following liver resection What is already known: Higher compliance (adherence) to ERAS pathways has been shown in different types of surgery to improve postoperative outcomes. Data on this subject in ERAS for liver surgery remain scant. What this paper adds: This before-and-after study from the University of Rochester Medical Center discusses the impact of early postoperative compliance to ERAS components on patient outcomes following liver surgery. The study included 210 patients who underwent liver resection between 2016 and 2020 at a single academic medical center. Patients after ERAS implementation had shorter mean length of hospital stay than pre-ERAS patients (5 vs. 7 days, p=0.0014). The study found that patients who were compliant with 9 ERAS items on postoperative day (POD) 3 had a shorter length of hospital stay (HR 5.4, 95% CI 3.3-8-8, p<0.001) and fewer complications compared to those who were less compliant (12% vs. 39%, p<0.001). This study suggests that compliance on POD3 with ERAS elements may be a useful predictor of patient outcomes following liver resection surgery. It highlights the importance of implementing ERAS programs and monitoring compliance to improve patient outcomes. Reference Burchard PR, Dave YA, Loria AP, Parikh NB, Pineda-Solis K, Ruffolo LI, et al. Early postoperative ERAS compliance predicts decreased length of stay and complications following liver resection. HPB (Oxford). 2022;24(9):1425–32.   ### ERAS® protocol improves survival after radical cystectomy: A single-center cohort study ERAS® protocol improves survival after radical cystectomy: A single-center cohort study.François Crettenand, Olivier M'Baya, Nuno Grilo, Massimo Valerio, Florence Dartiguenave, Yannick Cerantola, Beat Roth, Jean-Daniel Rouvé, Catherine Blanc, Ilaria Lucca. Medicine. 2022 Sep 2;101(35):e30258 What is known: ERAS pathways have a number of clearly defined short-term benefits but there is emerging evidence that there could be longer term benefits including cancer survival. E.g. here What this study adds: This is a single centre, retrospective study and clearly the results should be read with caution, but its an important addition to the colorectal data suggesting the longer term benefits of ERAS pathways. Chris Jones, Guildford. ### Future Perspectives on Prehabilitation Interventions in Cancer Surgery Future Perspectives on Prehabilitation Interventions in Cancer Surgery. Jensen BT, Baldini G. Seminars in Oncology Nursing. Epub 2022 Aug 12 What is already known: Prehabilitation is an attractive component of improving patients perioperative outcomes, but the evidence of improved perioperative outcomes in those receiving prehabilitation is limited. Despite this, it continues to remain a key component of “moderate” recommendation grades in guidelines. What this paper adds: This paper explores the prehabilitation landscape, and the authors review key areas they deem to be “knowledge gaps”; smoking and alcohol excess, the geriatric syndrome, cognitive impairment including comprehensive geriatric assessments and frailty. Whilst exploring these areas, they recommend the integration of prehabilitation strategies into enhanced recovery pathways. The authors also discuss the benefit of therapeutic delay to allow treatment of modifiable risk factors prior to proceeding with cancer surgery; reducing short term perioperative complications occurring as a consequence of improperly optimised patient. Andy Kermode, Guildford ### Enhanced recovery after surgery (ERAS) in Latin America: The story so far Santiago M. Mata-Suarez, Santiago Mc Loughlin, U. Fraidenraij, A.O. Alvarez. Enhanced recovery after surgery (ERAS) in Latin America: The story so far. Best Pract Res Clin Obstet Gynaecol 2022 Aug 2;S1521-6934(22)00105-5 What is already known: ERAS programmes are now firmly embedded into healthcare systems of high income countries, this unfortunately cannot be said of low and middle income countries. What this paper adds: In this interesting review, the authors discuss the development and establishment of ERAS pathways in Latin America. They also shed light on current challenges and future perspectives on perioperative optimization in the region. Chris Jones, Guildford. ### Impact of analgesic techniques on early quality of recovery after prostatectomy: a 3‐arm, randomised trial Impact of analgesic techniques on early quality of recovery after prostatectomy: a 3‐arm, randomised trial. Beilstein CM, Huber M, Furrer MA, Löffel LM, Wuethrich PY, Engel D. European Journal of Pain. Epub 2022 Aug 12 What is already known: Analgesic strategies after prostatectomy vary international and nationally between institutions. Strategies include opiates, ketamine, clonidine and gabapentoinds, and potential the inclusion of a regional and central neuraxial techniques, with transversus abdominus plane (TAP) blocks and spinal anaesthetics being the most commonly employed techniques respectively. What this paper adds: This paper utilises a holistic review of post-operative recovery, utilising a Quality of Recovery questionnaire rather than focussing on pain scores. As such, the results of this study are difficult to compare to those focussed on pain scores or analgesic requirements. The protocol compares 3 analgesic strategies in a prospective, randomised, 3 arm, parallel group superiority trial. It compares a single shot spinal technique, TAP blocks and the control group receiving systemic analgesia with an IV lidocaine bolus and infusion for 24hours. All patient arms received ketorolac, paracetamol and metamizol. No statistical difference was identified between techniques, either at day one or discharge. This facilitates clinicians choosing techniques which fit their institution. ### Delayed return of gastrointestinal function after hepatectomy in an ERAS program: incidence and risk factors Expert review Delayed return of gastrointestinal function after hepatectomy in an ERAS program: incidence and risk factorsSara Arfa et al. HPB. 2022 (1) What is already known: Oral nutrition can be initiated early after hepatectomy, and ERAS guidelines recommend oral nutrition after liver surgery (2). Moreover, one RCT and one recent meta-analysis showed that routine use of nasogastric tube was not recommended after hepatectomy (3,4). Use of laxatives after liver surgery might decrease the time to first stool but do not have an impact on postoperative complications (5). What this paper adds: This cross-sectional study from Besançon, France included 206 patients who underwent hepatectomy (86 major hepatectomies, 42%; 19 biliary resections, 9%; 20 combined vascular resections, 9%) and followed an ERAS pathway. Patients routinely received oral magnesium hydroxide twice a day until return of gastrointestinal function. It was not specified if patients received prokinetics during the postoperative period. A total of 41 patients (20%) had delayed return of gastrointestinal function, defined as need of nasogastric tube insertion. The authors found that older age, vascular reconstruction, anesthetic induction using gas, and epidural analgesia were independent risk factors for delayed return of gastrointestinal function. Major hepatectomy was more frequent in the group with delayed return of gastrointestinal function compared to the group without need of nasogastric tube insertion. Interestingly, left-sided resection – often associated more frequently with delayed gastric emptying than right hepatectomy – was not found as a predictive factor of delayed return of gastrointestinal function (p=0.404), but the number of left-sided resections in each group was not mentioned. The rates of biliary resections were also similar in both groups. This study showed that delayed return of gastrointestinal function was frequent after hepatectomy in ERAS patients and can have negative consequences (6 patients developed pneumonia, and 1 among them had to be intubated). It remains unclear if this delayed return of gastrointestinal function is mainly linked to delayed gastric emptying or to paralytic ileus. Future studies should focus on developing strategies to mitigate this delayed return of gastrointestinal function in patients at risk. 1. Arfa S, Turco C, Lakkis Z, et al (2022) Delayed return of gastrointestinal function after hepatectomy in an ERAS program: incidence and risk factors. HPB. Online ahead of print (PMID35484074) 2. Melloul E, Hübner M, Scott M, et al (2016) Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 40:2425–2440 3. Ichida H, Imamura H, Yoshimoto J, et al (2016) Randomized Controlled Trial for Evaluation of the Routine Use of Nasogastric Tube Decompression After Elective Liver Surgery. J Gastrointest Surg 20:1324–1330 4. Wen Z, Zhang X, Liu Y, et al (2019) Is routine nasogastric decompression after hepatic surgery necessary? A systematic review and meta-analysis. Int J Nurs Stud 100:103406 5. Hendry PO, van Dam RM, Bukkems SF, et al (2010) Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. Br J Surg 97:1198–1206 ### Review Prehabilitation for Vascular Surgery Patients: Challenges and Opportunities Article: Shovel L and Morkane C. Review Prehabilitation for Vascular Surgery Patients: Challenges and Opportunities. Canadian Journal of Cardiology 38 (2022) 645e653 What is already known: In ERAS, prehabilitation is a common practice to improve the patient's functional capacity before major surgery, especially in frailty and physical inactivity people. Prehabilitation is important in case of significant physiologic stressors in terms of dietetic and psychologic support to improve the patient's outcome. This approach allows the patient to have a quicker recovery and a reduced length of hospital stay and reduced postoperative morbidity. During the pandemic, the patient performed prehabilitation with home-based exercise; meanwhile, usually an expert paramedic would monitor the patient evaluating for the best exercise. In vascular surgery, a patient's preoperative functional status plays a crucial role in their ability to withstand the surgical stress response associated with peripheral arterial disease (PAD) or abdominal aortic aneurysm (AAA) repair, even though the exercise should not be too heavy because the PAD could affect the reduction in the activity and the aneurysmatic pathology could be negatively affected by the intensive exercise. So management of risk factors and exercise before the intervention are the prehabilitation conditions to improve the outcome. What this paper adds: Since prehabilitation models remain heterogeneous, with little consistency or best practice agreed on in the literature, this review can explore what could be a good approach and protocol for it. While in vascular surgery there is an apparent lack of good-quality evidence of benefit, in oncologic one, there are strong indications that prehabilitation is working but face-to-face group classes are still standard of care because, otherwise, exercise programs are likely to fail or be significantly less successful. Regarding prehabilitation, before abdominal aortic aneurysm treatment, different papers reported implementation of the exercise regimens with training intensity and frequency varying wildly between studies: inspiratory muscle training for a minimum of 2 weeks before surgery, others assessing the impact of 6 weeks of preoperative supervised exercise, the feasibility of high-intensity training (HIT) 3 times per week for 4 weeks, and investigation of preoperative physical activity through 6-minute walking distance. Literature disagrees about the preoperative exercise. Some authors suggest a benefit in the length of stay and quicker recovery; others reported utterly different data. These topics make it difficult to recommend prehabilitation and exercise as a standard of care in vascular surgery, and it is considered a future research target. In fact, large AAA (more than 7 cm) has a significant risk of rupture due to potential exercise-induced blood pressure surges; training in patients with early (< 5.5 cm) AAA disease has been well established as a safe activity. Exercise may help in AAA suppression having a protective role against its increasing and expansion. For this reason, prehabilitation programs offer an opportunity to begin exercise training and modify lifestyle behavior when aneurysms are small and not considered for treatment yet: patients may be psychologically more receptive to risk factors and incorrect behavior changes during this time. In this program costs should be a problem to address because the vascular perioperative pathways (also prehabilitation) involve different healthcare figures such as vascular surgeons, vascular nurse specialists, physiotherapists and exercise therapists, dieticians, occupational therapists, and anesthesiologists. In PAD, claudicants and amputees may find the generic or group exercises used in prehabilitation unfeasible because of either pain or inability to stand or balance. These patients may require sitting or upper limb exercises delivered at home or in person. Physical fitness benefits almost every context of health and disease, and mounting evidence confirms the relationship between physical fitness and improved perioperative outcomes. ### Scoping review of frailty in vascular surgery Scoping review of frailty in vascular surgery. Drudi LM, Ades M, Landry T, Gill HL, Grenon SM, Steinmetz OK, Afilalo J. Journal of Vascular Surgery 2019 Jun;69(6): 1989-1998 What is already known: Preoperative risk stratification for surgical procedures is key to informed decision-making for patients undergoing interventions for vascular diagnoses. However, traditional risk prediction models focus on factors such as age and comorbidities and fail to account for the physiologic reserve that significantly impacts a patient’s risk for complications and recovery following procedure. Frailty assessments can provide information on the physiologic reserve that a patient has and their vulnerability to stressors. Frailty assessments can therefore provide complementary information to traditional preoperative risk assessments by improving the ability to predict functional recovery and quality of life after surgery. Frailty assessments may be particularly applicable in vascular surgery patients as they are typically older with multiple comorbidities and physical limitations. Although not a standard component of enhanced recovery after surgery (ERAS), there may be an opportunity to incorporate frailty assessments in ERAS pathways to enhance discussions of postoperative expectations or to prompt preoperative interventions to counter the effects of frailty. What this paper adds: This paper identified current frailty assessments in vascular surgery patients, the extent of the evidence base and recurring themes and gaps in the literature related to frailty in vascular surgery. There are multiple methods that have been employed to assess frailty in vascular surgery patients and the method impacts the prevalence (. In patients with vascular disease and in particular symptomatic peripheral arterial disease (PAD), it can be challenging to differentiate between baseline frailty and impairments from their disease, particularly if their presentation is acute. However, regardless of the frailty assessment used, frail patients who undergo common vascular procedures have increased risk of mortality, morbidity and other adverse outcomes such as cognitive impairment and functional impairment. Future directions include identification of the ideal frailty score for vascular surgery patients and to determine how a specific score correlates with operative risk. Improved diagnostic and prognostic capability of specific frailty scores can then provide additional opportunity to study how to care for frail patients undergoing vascular surgery. ### Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicenter, double-blind, randomized, placebo-controlled superiority trial. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicenter, double-blind, randomized, placebo-controlled superiority trial.Haal S, Guman M, Boerlage T, Acherman,Y, de Brauw M, Bruin S, de Castro S, van Hooft J, van de Laar A, Moed D, Schouten R, van Soest E, van Veen R, de Vries C, Dijkgraaf M, Gerdes V, Voermans RLancet Gastroenterol Hepatol. 2021 Dec;6(12):993-1001. What is already known Severe obesity as well as rapid weight loss are well known risk factors for gallstone formation. An increased risk for symptomatic gallstone disease and cholecystectomies has been reported after bariatric surgery. In the case of choledocholithiasis, the altered anatomy after Roux-en-Y gastric bypass makes the clinical solutions for these circumstances complex. Although there are previous studies reporting reduced formation of gallstones after bariatric surgery when using ursodeoxycholic acid during the initial rapid weight-loss phase, there is a lack of level-1 evidence supporting prevention of symptomatic gallstone disease. What this paper adds In this double-blinded, placebo-controlled trial including 967 patients, a prophylactic dose of 900 mg of ursodeoxycholic acid daily for 6 months did not significantly reduce symptomatic gallstone disease during 2 years after primary Roux-en-Y gastric bypass and sleeve gastrectomy in all patients. However, in a subgroup analysis, patients with no visible gallstones at baseline who later underwent Roux-en-Y gastric bypass had a reduced risk for symptomatic gallstones (OR 0.37). Although the exact role for ursodeoxycholic acid in the perioperative care during bariatric surgery still remains unclear, the results of this study are convincing and suggests that prophylactic use of ursodeoxycholic acid after Roux-en-Y gastric bypass may be considered for patients who do not have gallstones disease before surgery. The need for a routine ultrasound to confirm this might limit its use. Moreover, further studies are needed in order to confirm the generalizability of the results in relation to other bariatric procedures such as sleeve gastrectomy. Anders Thorell and Erik Stenberg ### Enhanced recovery after surgery (ERAS): barriers and solutions for nurses Enhanced recovery after surgery (ERAS): barriers and solutions for nurses. Angie Balfour, Jeanette Amery, Jennie Burch, Henriette Smid – NanningaAsia-Pacific Journal of Oncology Nursing. In Press – Journal Pre-proof https://doi.org/10.1016/j.apjon.2022.02.002 What is already known: ERAS pathways have been in place for over 20 years and have obviously shown a great deal of success. Despite this we are still seeing barriers to their implementation. Our nursing colleagues are vital members of the team and being closer to the ground, have unique insights into the implementation of ERAS pathways – both positive and negative. What this paper adds: In this article some senior members of the ERAS Nursing AHP Group identify a number of common barriers to successful implementation, and more importantly offer up solutions to these common problems. A hugely important and useful article! Chris Jones, Guildford. ### Enhanced Recovery After Surgery in Octogenarians undergoing hepatopancreatobiliary surgery Enhanced Recovery After Surgery in Octogenarians undergoing hepatopancreatobiliary surgery Jordan N Robinson, Joshua M K Davis, Ryan C Pickens, Allyson R Cochran, Lacey King, Patrick Salibi,, David A Iannitti, John B Martinie, Erin H Baker, Lee M Ocuin, Dionisios Vrochides. Am Surg 2021 Dec 4;31348211054063.doi:10.1177/00031348211054063 What is already known: The application of ERAS after hepato-pancreato-biliary (HPB) surgey is associated with improved postoperative outcome. However, its actual benefit for very elderly patients undergoing major HPB surgery needs to be established. What this paper adds: This single-center retrospective cohort study compared patients aged 80 years or older with major elective HPB surgery before and after ERAS implementation. A majority of patients (31 out of 35) had a pancreatic surgery. The median compliance to ERAS was 64%. The thirty-day readmission rate was significantly reduced from 50% to 15% (p = 0.037) following ERAS implementation. This study shows that ERAS for octogenarian after major HPB surgery is feasible and may be associated with more sustainable recovery. ### Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients Impact of 2016 Enhanced Recovery After Surgery (ERAS) Recommendations on Outcomes after Hepatectomy in Cirrhotic and Non-Cirrhotic Patients Thibault Lunel et al. World J Surg. 2021 (6)   What is already known: ERAS has been shown to be safe and to improve outcomes in liver surgery (1,2). Several studies and meta-analyses have shown that ERAS in liver surgery allowed decreasing postoperative complications, length of stay, and costs (3-5).   What this paper adds: This cross-sectional study compared ERAS management vs. non-ERAS management (historical control group before ERAS implementation) in liver surgery patients. After inverse probability of treatment weighting, the authors confirmed previous findings in non-cirrhotic patients (improved Comprehensive Complication Index, length of stay, and textbook outcomes with ERAS). The other interesting finding was that postoperative outcomes were not different between ERAS and non-ERAS patients in the subgroup of cirrhotic patients. Of note, the cirrhosis subgroup was rather small (n=59 ERAS, n=46 non-ERAS) and the compliance rate to ERAS guidelines was lower than recommended (60%). ERAS in cirrhotic patients needs further investigation. ### Short‑term outcome in robotic vs laparoscopic and open rectal tumor surgery within an ERAS protocol: a retrospective cohort study from the Swedish ERAS database. Daniel Asklid, Olle Ljungqvist, Yin Xu, Ulf O. Gustafsson Short‑term outcome in robotic vs laparoscopic and open rectal tumor surgery within an ERAS protocol: a retrospective cohort study from the Swedish ERAS database. Surgical Endoscopy (2021) https://doi.org/10.1007/s00464-021-08486-y   What is already known:   The robotic platform has in a very short time been widely implemented in colorectal surgery and may have advantages over laparoscopic techniques, especially in rectal surgery, because of superior three-dimensionalview and a shorter learning curve compared to the laparoscopic approach. However, the current evidence in favor for robotic surgery is sparse, and not often studied within the ERAS protocol. Although a few retrospective cohort studies indicate improved short-term outcomes in favor of robotic rectal surgery, the majority of randomized controlled trials (RCTs) have been underpowered and meta-analyses have not been able to confirm these results.   In this large multicenter, EIAS register-based cohort study, short-term outcomes in robotic, laparoscopic and open rectal tumor resections were compared.   What this paper adds: All patients scheduled for rectal tumor resection and consecutively recorded in the recently validated Swedish part of EIAS between 2010 to 2020, were included (N = 3125). Primary outcomes were postoperative complications and length of stay (LOS) and secondary outcomes compliance to the ERAS protocol, conversion to open surgery, symptoms delaying discharge and reoperations. Robotic surgery (N = 827) had a similar rate of postoperative complications, 35.9% compared to open surgery (N = 1429) 40.9% and laparoscopic surgery (N = 869) 31.2%. LOS was longer in the open group, median 9 days and laparoscopic group, 7 days compared to the robotic group, 6 days. Pre- and intraoperative compliance to the ERAS protocol were similar between groups. The authors conclude that except from shorter LOS, the differences in favor for robotic surgery are limited in an ERAS setting.     Additional comment:   This article comes from my own research group which makes a review inappropriate. However, the important thing is to encourage more large-scale studies using data in the international EIAS database, currently containing more than 100,000 colorectal patients. By using the database, the perioperative period and outcome from surgery can be analyzed and compared in detail and be related to other variables that may impact the main clinical outcomes. This may reflect the true clinical reality to a larger extent compared to the study environment in many randomized studies. ### Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis Hamid HK, Emile SH, Saber AA, Ruiz-Tovar J, Minas V, Cataldo TE Laparoscopic-Guided Transversus Abdominis Plane Block for Postoperative Pain Management in Minimally Invasive Surgery: Systematic Review and Meta-Analysis J Am Coll Surg. 2020 Sep;231(3):376-386.e15. doi: 10.1016/j.jamcollsurg.2020.05.020. Epub 2020 Jun 2.   What is already known:   Optimal multimodal analgesia constitutes one of the ERAS interventions, but the evidence base in favor for one optimal analgesic regimen compared to another is currently weak. Transversus abdominus plane (TAP) block has recently been shown to reduce post-operative pain and opioid consumption resulting in enhanced mobilization after surgery. A TAP block is performed by injecting local anesthetics into the nervous plane in between the transverse and external muscles in the abdominal wall, thereby blocking the nerves responsible for transmitting pain from the laparoscopic incisions during surgery. This has traditionally been performed by an anesthesiologist using ultrasound (ULTAP) to guide the needle for injection into the right plane of the abdominal wall, but this procedure can be cumbersome and time consuming and can cause a prolonged duration of anesthesia for patients.   Therefore, a novel laparoscopic technique without the use of ultrasound has been described (LAPTAP) which can be performed by the surgeon during the operation and may shorten anesthesia since the method requires less elaborate preparation.   Th current meta-analysis compares the efficacy of the efficacy and safety of the novel laparoscopic-guided transversus abdominis plane block (LATAP) with other analgesic alternatives in adults undergoing minimally invasive surgery.   What this paper adds:   After a systematic literature search for randomized controlled trials (RCTs) reporting on LAPTAP, 19 RCTs with 1,983 patients were included. Primary outcomes were pain scores at rest and movement at 24 hours postoperatively. All trials compared LATAP with ULTAP, local infiltration analgesia (LIA), or inactive control. LAPTAP provided equal pain control compared with ULTAP, and better early pain control compared with local infiltration analgesia. Recovery parameters, 24-hour opioid consumption, and postoperative nausea and vomiting (PONV) were equal between LAPTAP and ULTAP. The authors conclude that LAPTAP can be used as a safer and pragmatic alternative to epidural analgesia in laparoscopic or robotic abdominal procedures.   Additional comment:   In many centers, TAP is currently a standard procedure within multimodal analgesia in minimal invasive abdominal surgery. However, although the technique is suitable in many patients, additional treatment with other modalities is often necessary. Further research on an optimal postoperative analgesia regimen is warranted. ### Effect of Short-Term Homebased Pre- and Postoperative Exercise on Recovery after Colorectal Cancer Surgery (PHYSSURG-C): A Randomized Clinical Trial Onerup A, Andersson J, Angenete E, Bock D, Börjesson M, Ehrencrona C, Olsén MF, Larsson PA, de la Croix H, Wedin A, Haglind E, Sweden Effect of Short-Term Homebased Pre- and Postoperative Exercise on Recovery after Colorectal Cancer Surgery (PHYSSURG-C): A Randomized Clinical Trial Ann Surg. 2021 Apr 9. doi: 10.1097/SLA.0000000000004901. Online ahead of print. PMID: 33843798   What is already known:   The preoperative period may provide an opportunity to increase the physiologic reserve in the anticipation of surgery with the intention to improve outcomes and accelerate recovery. Therefore, preoperative optimisation or ‘‘prehabilitation’’ can be a compelling strategy to address modifiable risk factors that impact cancer treatment outcomes. Prehabilitation is defined differently in different studies, ie only physical training, physical training and nutrition or physical training with many additional interventions before surgery. Thus, the evidence base is heterogenic which makes it difficult to draw firm conclusions. So far evidence in favor for prehabilitation before colorectal surgery are indicating improved functional capacity, but evidence for a decrease in complications are weak. Therefore, prehabilitation could not be fully recommended in colorectal guidelines 2018.   Since 2018, three meta-analyses have been published (major abdominal surgery), two showing a reduced rate of complications (Heger, 2019 and Daniels 2020) and one showing no difference at all in favor for prehabilitation. However, as mentioned above, it is difficult to make conlusions because these studies suffer from heterogeneity issues.   In 2020, Carli et al published a RCT on 110 “frail” patients undergoing multimodal prehabilitation showing no difference in complications or LOS. However, the study was probably underpowered.   The current study is a large, well conducted RCT from Sweden comparing physical training vs standard with self-reported postoperative physical recovery as primary outcome.   What this paper adds:   A randomized, parallel, open-label trial in six university or regional hospitals in Sweden. Participants planned for colorectal cancer surgery were randomized to either a physical activity intervention with aerobic activity and inspiratory muscle training two weeks pre- and four weeks postoperatively or usual care. Six hundred and sixty-eight patients were analysed, 317 in the intervention (I) group and 351 in the control group (C). Self-reported postoperative physical recovery was measured showing no difference between groups with 13% and 15% of participants feeling fully physically recovered in I and C respectively.   The authors conclude that the results from the study call for reconsiderations regarding current recommendations for preoperative physical activity interventions.     Additional comment:   There are a couple of weaknesses in the study that may make the results difficult to interpret. First, homebased exercise is difficult to evaluate because of the risk of lack of compliance. In this study, only 63% of the included patients did report activity. Secondly, the level of exercise in this study must be regarded as low intensity training. High intensity training may have shown a different outcome.   In conclusion, since 2018, the state of evidence in favor for prehabilitation has not been strengthened. But there are several ongoing multicenter RCTs that may answer questions about prehabilitation in the future. ### Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery. Paul Andrew Drakeford, Shu Qi Tham, Jia Li Kwek, Vera Lim, Chien Joo Lim, Kwang Yeong How, Olle Ljungqvist, Singapore / Sweden. Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery. World J Surg (2022) 46:19–33 https://doi.org/10.1007/s00268-021-06343-6.     What is already known:   It is known that acute kidney injury (AKI) is a common complication following major abdominal surgery and is associated with increased length of hospital stay, the progression of chronic kidney disease (CKD), and increased long-term mortality. The ERAS protocol promotes several measures which aim to maintain near euvolaemia such as preoperative carbohydrate loading, avoidance of bowel preparation, minimisation of fasting times, minimally invasive surgery, and early resumption of oral fluid therapy.   High compliance to those items in conjunction with recommendation of a balanced perioperative intravenous fluid regimen is proposed to limit complications such as paralytic ileus and sequelae from fluid overload, while failure to implement those measures may predispose patients to intravascular volume depletion and hence increase their risk of AKI.   Three recent studies have published results indicating an increase in AKI after implementing an ERAS-like enhance recovery programs for colorectal cancer surgery. The current study presents new results and discuss the outcome from previously published studies.     What this paper adds:   In this single center cohort study 74 out of 555 patients (13%) operated on with colorectal surgery within an ERAS protocol met criteria for AKI. The majority of them were Stage 1 AKI (84%). Sixty-seven of the cases with AKI (90.5%) occurred within the first 48 h after surgery. Of those diagnosed with AKI, all but two had their S-Creatinin value returned to within normal range or within 10% of baseline by the time they were discharged. After multivariable regression analysis, factors associated with AKI were high preoperative creatinine , the use of open vs robotic surgery, long anaesthesia duration and a higher rate of major complications.   The authors conclude that the implementation of an ERAS program for CRS was associated with a low prevalence of moderate to severe AKI despite a balanced intravenous fluid regimen. How then, can the difference in outcome between the current study and previously published studies indicating a higher risk for postoperative AKI be explained? The authors point out a major drawback with previous studies, namely the lack of data on other perioperative care elements than fluid management. Since the occurrence of AKI is depending on several factors, available data on all perioperative interventions is necessary to draw firm conclusions on the ERAS protocol. Additional comment:   Although the risk of severe AKI is low in patients who are compliant to the ERAS protocol, a balanced perioperative intravenous fluid regimen avoiding fluid deficit, is important. ### Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis. Shim JW, Kim KR, Jung Y, Park J, Lee HM, Kim YS, Moon YE, Hong SH, Chae MS, South Korea. Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis. PLoS One. 2020 Apr 17;15(4): doi: 10.1371/journal.pone.0231447.  PMID: 32302336   What is already known:   It is known that acute kidney injury (AKI) is a common complication following major abdominal surgery and is associated with increased length of hospital stay, the progression of chronic kidney disease (CKD), and increased long-term mortality. The ERAS protocol promotes several measures which aim to maintain near euvolaemia such as preoperative carbohydrate loading, avoidance of bowel preparation, minimisation of fasting times, minimally invasive surgery, and early resumption of oral fluid therapy.   High compliance to those items in conjunction with recommendation of a balanced perioperative intravenous fluid regimen is proposed to limit complications such as paralytic ileus and sequelae from fluid overload, while failure to implement those measures may predispose patients to intravascular volume depletion and hence increase their risk of AKI.   In the last three years, three studies have published results indicating an increase in AKI after implementing an ERAS-like enhance recovery programs for colorectal cancer surgery. The current study is the most recent one, published in 2020.     What this paper adds:   In patients undergoing laparoscopic colorectal cancer resection within an ERAS protocol, 125 out of 453 (28%) met the criteria for oliguria and were propensity score matched to 328 patients without intraoperative oliguria. The incidence of AKI and rate of postoperative complications was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2% and 18.4% vs 9.6%, respectively).   The authors conclude that despite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI.   Additional comment:   The outcomes from the current study and the two previously published studies high lightening the risk of AKI are discussed in the recently published “Acute Kidney Injury within an Enhanced Recovery after Surgery (ERAS) Program for Colorectal Surgery”, Drakeford at al, also commented on this website.     ### The Application of ERAS for Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis. The Application of Enhanced Recovery After Surgery (ERAS) for Patients Undergoing BariatricSurgery: a Systematic Review and Meta-analysis. Zhou J, Du R, Wang L, Wang F, Li D, Tong G, Wang W, Ding X, Wang D. Obes Surg. 2021 Mar;31(3):1321-1331.  What is already known Since the implementation of the first ERAS guidelines for bariatric surgery, a number of studies evaluating effects of an ERAS pathway have been published. While these studies have been too small to evaluate complications or other more hard endpoints, a reduction in postoperative length of stay have been reported. Given the low complication rates of modern bariatric surgery, other outcomes such as readmission, nausea, and control of pain may be of importance.   What this paper adds The paper describes the largest systematic review and meta-analysis on the effect of adherence with ERAS recommendations on postoperative outcomes after bariatric surgery, including 5 RCTs and 12 observational studies with 4964 patients in the ERAS group and 3218 patients in a standard care group. Despite the relatively high number of included patients, the study is still too small to evaluate postoperative complications. However, in equivalence with previous studies, length of stay was reduced in the ERAS group without any increase in the risk for complications or hospital readmission. The authors were also able to demonstrate a significant reduction in postoperative nausea and vomiting. Given the low rate of serious complications at present, these are important endpoints with an influence on recovery and patient satisfaction. Larger studies addressing other important endpoints are still needed, but given the fact that many of the most important ERAS items are generally implemented in standard care already, this may prove difficult to assess within RCTs. ### Implementing enhanced recovery after bariatric surgery protocol: a retrospective study Implementing enhanced recovery after bariatric surgery protocol: a retrospective study Proczko M, Kaska L, Twardowski P, Stepaniak P. Implementing enhanced recovery after bariatric surgery protocol: a retrospective study. J Anesth. 2016 Feb;30(1):170-3. What is already known: ERAS programmes have been widely shown to reduce hospital length of stay for a number of surgical specialities, particularly through early post-operative mobilisation and multi-modal analgesia. Outside of ERAS much research has looked into the benefits of non-clinical interventions – human factors – on clinician’s performance and subsequent patient outcomes across the medical field. What this paper adds: This brief paper demonstrates the successful implementation of an ERAS programme for bariatric surgery with reduced hospital length of stay alongside some other interesting benefits. Both operating and anaesthetic times were reduced as was the turnover time between cases. The paper does not detail the individual ERAS elements adhered to, but the programme includes a number of interventions aimed at improving the human factors of a bariatric list including a “working with a fixed team” concept whereby the surgeons, anaesthetists and circulating nurses work together on a regular basis improving the overall team’s efficiency. Cases were concentrated on specific lists during the week rather than being spread out across several lists with different teams. Although logistically challenging such interventions can improve theatre efficiency significantly alongside patient-specific outcomes. Ben Morrison, Guildford. ### An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1? An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1? Lam J et al. An ERAS protocol for bariatric surgery: is it safe to discharge on post-operative day 1? Surg Endosc. 2019 Feb;33(2):580-586. What is already known: The ERAS society published guidelines for Bariatric surgery in 2016 [they can be found here]. Bariatric surgery has been shown to help improve or resolve many obesity-related conditions, such as type 2 diabetes, high blood pressure, heart disease, and more. Laparoscopic Sleeve Gastrectomy is one of the most commonly performed bariatric operations in the USA. What this paper adds: This was a single centre retrospective review of their programme after it had been introduced. They included over 200 patients and with a comprehensive ERAS pathway they showed that after laparoscopic surgery patients could be safely discharged on postoperative day 1. With no difference in readmission rates, post-operative complications or mortality. They also found with a good multimodal analgesic programme they could reduce intraoperative opioid use and still reduced pain scores on postoperative day 1. Chris Jones, Guildford. ### Applying Enhanced Recovery After Bariatric Surgery (ERABS) Protocol for Morbidly Obese Patients With End-Stage Renal Failure Applying Enhanced Recovery After Bariatric Surgery (ERABS) Protocol for Morbidly Obese Patients With End-Stage Renal Failure Proczko M et al. Applying Enhanced Recovery After Bariatric Surgery (ERABS) Protocol for Morbidly Obese Patients With End-Stage Renal Failure. Obes Surg. 2019 Apr;29(4):1142-1147 What is already known: ERAS protocols have been safely implemented in bariatric patients. Obesity is a known risk factor for the development of end stage renal disease (ESRD). No current studies have looked at the safety of ERAS protocols in patients requiring bariatric surgery as a bridge to organ transplantation in patients with ESRD. What this paper adds: This single centre retrospective study looked at propensity matched patients with ESRD undergoing bariatric surgery as a bridge to renal transplantation. This resulted in two groups of 19 patients. There were no significant differences in minor or major complications up to 30 days postoperatively. Only one patient in the ESRD group needed a re-operation due to an anastomotic leak. Length of stay was on average 1.8 days longer in the ESRD group due to the need for dialysis postoperatively. This small study confirms that Bariatric ERAS protocols are safe in patients with ESRD with no changes needed to the ERAS protocols. Katie Wimble, Guildford ### Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol Stefura T et al. Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol. Obesity Surgery. PMID: 30632072. DOI: 10.1007/s11695-018-03660-z What is already known: ERAS protocols have been safely implemented in bariatric patients to improve patient outcomes, reduce length of stay and lead to fewer postoperative complications. Bariatric Surgery is becoming increasingly prevalent and patients are usually advised to lose weight pre-operatively but the effects of this on perioperative complications when evaluated within an ERAS protocol have not yet been studied. Current ERAS Society guidelines for use in Bariatric Surgery state that preoperative weight loss as “strong” recommendation grade; but this is often overlooked due to barriers to its implementation. What this paper adds: This was a multicentre study looking at prospectively collected data on 909 bariatric patients undergoing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), using ERAS protocols, in two hospitals in Poland. They aimed to look at factors affecting preoperative weight loss and the effects weight loss had on short term outcomes. They separated patients into those who lost <5% of body weight and those >5% body weight pre-operatively. They found that factors associated with increased weight loss were presence of diabetes mellitus (p=0.027) and obstructive sleep apnoea (p=0.007). Steatohepatitis was more common (p <0.001) in those who lost < 5% and in male patients (p=0.02). The median operative times were significantly lower in patients who lost > 5% body weight (LSG p<0.001, LRYGB p=0.010). Patients who lost > 5% body weight went on to have higher median total weight loss on follow up (p=0.009). There was no difference in post-operative complication rates between to the two groups. Randomised studies looking into the effects of pre-operative weight loss are needed but this small study shows that preoperative weight loss can lead to reduced surgical times and greater overall weight loss after bariatric surgery. However not losing weight preoperatively did not increase complications postoperatively, showing the importance of a good ERAS programme. Katie Wimble, Guildford ### Introducing an ERAS programme across a provincial healthcare system. Introducing an ERAS programme across a provincial healthcare system. Nelson G, Kiyang LN, Crumley ET, Chuck A, Nguyen T, Faris P, Wasylak T, Basualdo-Hammond C, McKay S, Ljungqvist O, Gramlich LM. Implementation of Enhanced Recovery After Surgery (ERAS) Across a ProvincialHealthcare System: The ERAS Alberta Colorectal Surgery Experience. World J Surg. 2016 May;40(5):1092-103. What is already known: Most ERAS studies have been single centre and this is one of the first to describe how ERAS for colorectal surgery was implemented into a wider healthcare system in Alberta, Canada. What this paper adds: This study reports detailed results from six of Alberta’s 59 hospitals (but perform >70% of all colorectal surgery). After the ERAS programme was introduced compliance improved from 39% to 60%. They demonstrated an overall decrease in length of stay (6 to 5 days), readmissions, complications and some impressive cost savings (between $2806 and $5898 USD). Chris Jones, Guildford. ### A Meta-Analysis: Postoperative Pain Management in Colorectal Surgical Patients and the Effects on Length of Stay in an Enhanced Recovery After Surgery (ERAS) Setting. A Meta-Analysis: Postoperative Pain Management in Colorectal Surgical Patients and the Effects on Length of Stay in an Enhanced Recovery After Surgery (ERAS) Setting. Chemali ME1, Eslick GD. Clin J Pain. 2017 Jan;33(1):87-92. What is already known: Well managed pain relief aims to minimise side-effects and enable the main goals of ERAS to be achieved, including early mobilisation and early nutrition. What this paper adds: Optimal analgesia is an essential part of a successful ERAS programme, so the authors should be commended for conducting this important review. They included 21 separate RCT’s of several different types of analgesia comparisons, eg Lidocaine vs epidural, epidural vs PCA etc. This meta-analysis included colorectal RCT’s with pain as a major part of the study and length of stay as the main outcome. Overall they found no difference in their main outcome which was length of stay. However there are a number of flaws in this review. The studies they used were a mix of open and laparoscopic surgery, and not clear if all studies used a comprehensive ERAS programme as part of the standard care, in which case its difficult to draw accurate conclusions. Chris Jones, Guildford. ### Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Pisarska M, Pędziwiatr M, Małczak P, Major P, Ochenduszko S, Zub-Pokrowiecka A, Kulawik J, Budzyński A. Int J Surg. 2016 Dec;36(Pt A):377-382. What is already known: Higher compliance with all the ERAS elements have been shown to improve outcomes, including longer term oncological outcomes. Most single centre studies look at their population as one group, and compares to another control group, but this Polish study aimed to assess short term outcomes based purely on compliance. They split the patients into three groups – high compliance (>90%), medium (70-90%)and low compliance <70%. What this paper adds: This study adds further weight to the argument that increased compliance improves short term outcomes. But interestingly not just between low and high compliance but also between medium and high compliance. Chris Jones, Guildford. ### The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway. The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway. Chand M, De'Ath HD, Rasheed S, Mehta C, Bromilow J, Qureshi T. Int J Surg. 2016 Jan;25:59-63. What is already known: The wide-ranging benefits, including reduced hospital length of stay (LoS), of both laparoscopic surgery and ERAS have been well established. Perioperative complications are known to increase hospital LoS and mortality. What this paper adds: This study included a broad range of surgical procedures performed by a single surgeon using a standardised operative and anaesthetic technique. Details of patient inclusion/exclusion or compliance to ERAS guidelines are not given but it is inferred that all patients, having been recruited consecutively during the trial period, were fully followed-up with no exclusions and that there was no deviation from ERAS guidelines. The study protocol mentions the use of diclofenac, apparently as standard, for all procedures including those involving anastomosis creation (around 80% of procedures) with a 1% anastomotic leak rate. Ten patients were noted to have had a post-operative complication prior to initial discharge of which nine were classed as minor (Clavien-Dindo classification I or II) and these patients were all discharged on day two or three. The statistical analysis, however, showed an adjusted odds ratio of 16.26 for patients suffering a complication being more likely to experience a delayed discharge from hospital. It was also suggested that the study was likely underpowered to look into the effect of complications upon hospital LoS. 27 patients (9%) required readmission, the reasons for which are not detailed. Increased BMI and duration of operation were also suggested as predictors for delayed discharge but these had adjusted odds ratios of 1.06 and 0.99 respectively and of limited clinical significance. Ben Morrison, Guildford. ### Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis Katie E Rollins, Hannah Javanmard-Emamghissi, Dileep N Lobo.Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis. World J Gastroenterol 2018 January 28; 24(4): 519-536 What is already known: Mechanical bowel preparation (MBP) has long been part of surgical dogma; the rationale behind its use is that it reduces faecal bulk and, therefore bacterial colonisation, thereby reducing the risk of postoperativecomplications such as anastomotic leakage and wound infection, but slowly its routine use has been questioned. It has numerous physiological adverse effects secondary to the dehydration caused, it is distressing for the patient and is associated with prolonging ileus after surgery. There is also concern that it liquefies faeces and so may increase risk of spillage and therefore infection postoperatively. It remains somewhat controversial with advocates on both sides. In fact, it was even the subject of a Pro / Con debate at last year’s ERAS congress in Lyon. What this paper adds: This is an excellent and comprehensive meta-analysis by Professor Lobo’s group in Nottingham [NB Prof Lobo is the ERAS Society Scientific Chair]. It follows nicely on from the Cochrane review [2011], but with a further 5 RCT’s and includes over 21,500 patients versus almost 6000 in the Cochrane review. It demonstrates that at present there is no evidence that bowel preparation makes a difference to clinical outcomes in either colonic or rectal surgery, in terms of anastomotic leak rates, surgical site infection, intra-abdominal collection, mortality, reoperation or hospital length of stay. Given its potential adverse effects and patient dissatisfaction rates, it should not be administered routinely to patients undergoing elective colorectal surgery. Chris Jones, Guildford. ### Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Forsmo HM, Pfeffer F, Rasdal A, Sintonen H, Körner H, Erichsen C. Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Int J Surg. 2016 Dec;36(Pt A):121-126. doi: 10.1016/j.ijsu.2016.10.031. Epub 2016 Oct 22. What is already known: In most colorectal ERAS RCTs, patients undergoing stoma formation are often excluded. This small single-centre study looked specifically at patients undergoing colorectal surgery with stoma formation. What this paper adds: Whilst the authors did not define the specifics of their ERAS programme they did detail how their stoma nurse specialists focused on preoperative counselling and stoma education. Their programme demonstrated a 3 day reduction in hospital length of stay; showing that with proper preparation, undergoing stoma formation does not necessarily need to be a barrier against following a successful ERAS programme. Chris Jones, Guildford. ### Postoperative ERAS Interventions Have the Greatest Impact on Optimal Recovery: Experience With Implementation of ERAS Across Multiple Hospitals Postoperative ERAS Interventions Have the Greatest Impact on Optimal Recovery: Experience With Implementation of ERAS Across Multiple Hospitals Aarts MA, Rotstein OD, Pearsall EA, Victor JC, Okrainec A, McKenzie M, McCluskey SA, Conn LG, McLeod RS; iERAS group. Postoperative ERAS Interventions Have the Greatest Impact on Optimal Recovery: Experience With Implementation of ERAS Across Multiple Hospitals. Ann Surg. 2018 Jun;267(6):992-997. [And accompanying editorial: Ann Surg. 2018 Jun;267(6):998-999. ERAS Implementation-Time To Move Forward. Kehlet H.] What is already known: A great deal of work has already been done demonstrating how improved compliance with ERAS elements can improve both short-term and long-term outcomes. This is often in a 'dose-dependent' fashion with increasing compliance of all elements [e.g. Gustafsson - Arch Surg 2011, Pecorelli - Surg Endos 2016, ERAS Compliance Group - Annals of Surg 2015]. What this paper adds: This group was made up of clinicians from 15 academic hospitals in Ontario, and setup their own version of an ERAS pathway. The original project demonstrated a small 1 day improvement in length of stay with no change in readmissions. This paper aimed to determine which components of their ERAS programme had the greatest effect on recovery in colorectal surgery. This is a large study of almost 3000 patients conducted over a two-and-a-half-year period. Their self-designed programme only used 12 elements and were divided into pre, intra and post-operative pathways, with each having 4 elements. And therefore missed out on intra-operative elements such as temperature control, antibiotics etc, but also important pre-operative ones such as pre-optimisation inc prehabilitation. Patients were deemed compliant if they achieved at least 75% compliance (3 out of 4 of the elements in each pathway). Only 20.1% of all patients were compliant with all 3 pathways. Whilst 74.7% were compliant with the pre-operative elements only 40.3% were compliant with the post-operative elements. There were some excellent gains from baseline for example rates of preoperative counselling doubled from 41.4% to 82.2% and use of CHO went from 0% to 82%, after introduction of the programme. However, some elements were still poorly adhered to, e.g. use of goal-directed fluid therapy at only 26.7%. The authors suggest this is purely down to the fact that there was no additional funding available to the sites. But other more simple interventions were also not well adhered to, e.g. use of chewing gum post-operatively was only at 52.5%. Two potentially modifiable factors were found to significantly impact patient outcomes: laparoscopic surgery and preoperative haemoglobin levels. (A number of RCTs are in progress looking at how preoperative intravenous iron therapy can influence outcomes.) Overall higher compliance improved outcomes in both the laparoscopic and open group but the impact was significantly higher in the open group. The authors should be congratulated on size of the study and the multi-centred nature and the fact that it was prospective. But there were a number of limitations including only recording data from patients who consented, which could be a biased towards those patients who were naturally more motivated to follow the programme. The other issue is that as an observational study causation cannot be proved but only inferred. What are the real reasons for failure in following the post-operative elements? Are there proper medical / surgical reasons or simply organisational or logistical reasons? This is where our focus needs to be in the future and how to improve the compliance of all elements. Chris Jones, Guildford. ### American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery Anesth Analg. 2018 Jun;126(6):1896-1907. What is already known: A delayed return to normal GI function or the development of ileus will likely prolong hospital length of stay and several elements of ERAS are aimed towards the avoidance of GI complications. A number of definitions of ileus exist with considerable variation in their diagnostic criteria. What this paper adds: This paper is written by the Perioperative Quality Initiative (POQI) 2 workgroup, an international collaborative of experts in anaesthesia, surgery, nutrition and nursing. In order to better define ileus and aid in ascertaining its true incidence the group propose a rational definition of ileus or Post-Operative Gastrointestinal Dysfunction (POGD). The group propose a scoring system (I-FEED) comprising five elements helping to diagnose POGD. They go on to recommend a number of strategies aimed at reducing the incidence of POGD, several of which are found in ERAS protocols such as multimodal analgesia (with opioid avoidance) and avoidance of NG tubes. Other elements such as the use of chewing gum, coffee and alvimopan are reviewed and evidence-graded. The paper also includes evidence-based treatment strategies for patients developing POGD. Dr Ben Morrison ### Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population-based cohort study. Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population-based cohort study. Colorectal Dis. 2017 Nov;19(11):O393-O401. What is already known: VTE prophylaxis is an important but an often overlooked element of ERAS programmes. In the past VTE has a high morbidity and mortality, and most National guidelines have used old pre-ERAS evidence to base their recommendations. But now with ERAS programmes improving early mobilisation how has this affected the rate of symptomatic VTE, and in particular with only short-term VTE prophylaxis? What this paper adds: This Danish group conducted the first population-based cohort study to investigate the effect of in hospital only thromboprophylaxis within a colorectal ERAS programme. The risk of symptomatic venous thromboembolic events was found to be very low - only 0.2%. Raising the question of how beneficial is prolonged VTE prophylaxis for patients undergoing colorectal surgery within an ERAS programme. Randomised trials are warranted and national guidelines recommending prolonged thromboprophylaxis should be reconsidered. Chris Jones, Guildford. @chrisnjones ### Patient-reported outcomes 6 months after enhanced recovery after colorectal surgery Patient-reported outcomes 6 months after enhanced recovery after colorectal surgery Deiss T, Chen L, Sarin A, Naidu RK. Perioperative Medicine (2018) 7:19 What is already known: Many post-operative outcomes have been investigated and have been shown to be improved following implementation of an ERAS programme. The vast majority of these relate to inpatient stay and short-term (most commonly 30-90day) outcomes. Some studies have looked at longer-term outcomes including mortality and chronic pain and there is a strong association between chronic pain and opioid dependence. What this paper adds: This observational study identified a significant proportion of patients reporting persistent post-surgical pain (19%), dissatisfaction with their stay (14%) and hospital readmission (20%) within six months of their operation. These findings may suggest that a significant proportion of patients are suffering in the long-term following surgery despite being enrolled in an ERAS programme. The study did not, however, compare to outcomes before rolling-out an ERAS programme, nor did it give details of the programme itself. This study has demonstrated the potential for utilising automated telephone services as a screening tool for patients who may have experienced significant adverse outcomes postoperatively although they only achieved a 48% response rate. In an era where there is increasing concern over long-term opioid dependence, any methods which may help identify patients who have become opioid dependent should be investigated further. Ben Morrison, Guildford. @blouism ### Enhanced Recovery After Surgery: Can We Rely on the Key Factors or Do We Need the Bel Ensemble? Enhanced Recovery After Surgery: Can We Rely on the Key Factors or Do We Need the Bel Ensemble? Jurt J, Slieker J, Frauche P, Addor V, Solà J, Demartines N, Hübner M (2017)Enhanced Recovery After Surgery: Can We Rely on the Key Factors or Do We Need the Bel Ensemble? World J Surg. 2017 Oct;41(10):2464-2470.  What is already known: Lots of studies have shown that the higher the compliance with the ERAS elements the better the outcomes (both long and short; however, a lot of institutions find it difficult to adhere to all elements. This paper aims to assess the impact of each element to outcomes. What this paper adds: Minimally invasive surgery in this study was associated with reduced complications. However, the use of NG tubes, prophylactic abdominal / pelvic drains, thoracic epidurals and a high ASA score were all independent risk factors for complications. Like other papers looking at adherence, they found that with increasing adherence the better the outcomes and lower the complications. The threshold for adherence with the elements was 70%, below which complications rose and length of hospital stay increased. Chris Jones, Guildford. @chrisnjones ### Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study) Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study) Moya P, Soriano-Irigaray L, Ramirez JM, Garcea A, Blasco O, Blanco FJ, Brugiotti C, Miranda E, Arroyo A. (2016) Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol: A Multicenter Randomized Clinical Trial (SONVI Study). Medicine (Baltimore). 2016 May;95(21):e3704. What is already known: The evidence base for recommending immunonutrition is low and current ESPEN guidelines only recommend it for malnourished patients undergoing major cancer surgery. However, the most recent ERAS society guidelines do recommend immunonutrition based more on lack of harm rather than the quality of evidence base. This study is a multicentre RCT comparing an immune enhancing feed with a hypercaloric high-protein supplement in all patients undergoing colorectal surgery; and the first in patients following an ERAS pathway. What this paper adds: 244 patients were randomised to the two different supplements. Both groups followed a comprehensive ERAS programme and all other aspects of perioperative care were the same. Overall post-op complications were reduced in the immunonutrition group [23% vs 35%, p=0.035]; but in particular postoperative infectious complications [10.7% vs 23.8%, p=0.007]. This paper strengthens the evidence base for the use of immunonutrition as part of an ERAS pathway. Chris Jones, Guildford.  @chrisnjones ### The Use of the Enhanced Recovery After Surgery (ERAS) Protocol in PatientsUndergoing Laparoscopic Surgery for Colorectal Cancer--A Comparative Analysis of Patients Aged above 80 and below 55. The Use of the Enhanced Recovery After Surgery (ERAS) Protocol in PatientsUndergoing Laparoscopic Surgery for Colorectal Cancer--A Comparative Analysis of Patients Aged above 80 and below 55. Pędziwiatr M, Pisarska M, Wierdak M, Major P, Rubinkiewicz M, Kisielewski M, Matyja M, Lasek A, Budzyński A (2015) The Use of the Enhanced Recovery After Surgery (ERAS) Protocol in Patients Undergoing Laparoscopic Surgery for Colorectal Cancer--A Comparative Analysis of  Patients Aged above 80 and below 55. Pol Przegl Chir. 2015 Nov;87(11):565-72. What is already known: With increasing frailty and co-morbidities, age is often thought of as a barrier to successful outcomes after surgery. In this single centre Polish study, they compare post-operative outcomes in patients over the age of 80 years with those under the age of 55. What this paper adds: This was a small retrospective review of prospectively recorded data. All patients underwent laparoscopic colorectal surgery and followed a comprehensive ERAS program. Mean length of hospital stay was not significantly different between groups [5.4 days (>80yrs) vs 7 days (<55yrs), p=0.44]; nor postoperative complications or readmissions. Overall compliance of ERAS elements was impressively high in both groups [85% vs 83%]. Early mobilisation (<2 hours post-op) was also not impaired in the over 80 group [94% compliance vs 83%]. The only difference found, was that only 26% of >80yrs required opioids postoperatively compared with 55% of the <55yrs group. This study adds to the evidence that age should not be a barrier to surgery and that patients over the age of 80 can have similar outcomes to much younger patients. Chris Jones, Guildford.  @chrisnjones ### Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols Ban KA, Berian JR, Liu JB, Ko CY, Feldman LS, Thacker JKM (2018) Effect of Diagnosis on Outcomes in the Setting of Enhanced Recovery Protocols. Dis Colon Rectum. 2018 Jul;61(7):847-853. What is already known: A patient’s underlying diagnosis necessitating surgery is one of a number of factors previously shown to affect outcomes for patients undergoing colorectal surgery outside of an ERAS programme. Inflammatory bowel disease and acute mesenteric ischaemia appear to confer the highest risk of adverse outcomes alongside non-elective surgery and pre-existing comorbidities. What this paper adds: This paper looks retrospectively at outcomes for patients enrolled in an ERAS programme to see whether the underlying diagnosis remains an important predictor of outcome. Patients with neoplastic disease were found to be significantly more likely to have an ASA grade of III to V and have a higher risk of undergoing open surgery. Although ERAS compliance did not significantly differ between the diagnosis groups, overall compliance was generally underwhelming with only around a third of patients complying with 10 or more elements. This was a database analysis covering multiple centres thus details of individual ERAS programmes are not given. Overall, patients with IBD still appear to be at highest risk of serious complications despite the use of ERAS elements. It was noted that the extent of surgery in IBD patients was higher than in cancer or diverticular disease patients. The authors do comment on possible selection bias resulting from IBD patients being less likely to be enrolled on ERAS programmes or that those who were had a lower disease burden. The authors conclude that tailoring the patient education element of ERAS programmes for IBD patients may help improve their outcomes. Ben Morrison, Guildford. @blouism ### Promoting a culture of prehabilitation for the surgical cancer patient Promoting a culture of prehabilitation for the surgical cancer patient Carli F, Gillis C, Scheede-Bergdahl C. Promoting a culture of prehabilitation for the surgical cancer patient Acta Oncol. 2017 Feb;56(2):128-133. What is already known: Poor functional capacity is known to affect outcomes after surgery. Focus has now turned away from the postoperative to the preoperative phase and help prepare a patient for the insult that is surgery. But it is not just physical fitness; a cancer diagnosis can also have other affects on a patient, such as sarcopenia and malnutrition, as well as detrimental psychological effects. So the preoperative period is potentially an ideal time to make improvements in nutritional status and psychological health. What this paper adds: This interesting Canadian article reviews the literature on not only exercise programs, but also how to optimise nutritional status, and how psychological distress can influence functional capacity. Chris Jones, Guildford. @chrisnjones ### Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhance recovery protocol Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhance recovery protocol Kiyasu Y, Tsunoda A, Ohta T, Kusanagi H. Recovery of gastric ileus following laparoscopic ventral rectopexy within an enhance recovery protocol. Surg today. 2016 Aug;46(8):895-900. What is already known: Early oral feeding after surgery has become one of the key elements of ERAS protocols facilitating earlier hospital discharge. Historically laparoscopic ventral rectopexy as a treatment for rectal prolapse has been associated with a median length of stay of 3-6 days. This single centre study aimed to look at the degree of gastric ileus recovery by the postoperative evening using an ERAS protocol. What this paper adds: This study looked at the use of gastric ultrasound to evaluate the pyloric area as a surrogate for identifying gastric ileus. Scans were performed both pre and post-surgery, before and after ingestion of a standardised carbohydrate solution. They report that gastric ileus had resolved in most patients within 5 hours postoperatively and 90% of patients were discharged on the day following surgery having met full discharge criteria. They acknowledge that this is a small study of 40 patients, and it is unclear whether the ERAS protocol is responsible for the reduced length of stay and resolution of gastric ileus. This study provides further evidence to support early oral feeding as part of ERAS protocols. Their full ERAS protocol was published however the use of NG tubes and thoracic epidurals for laparoscopic cases appears at odds with current ERAS guidelines. Katie Wimble, Guildford. @wimble_katie ### Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Gonzalez-Ayora S, Pastor C, Guadalajara H, Ramirez JM, Royo P, Redondo E, Arroyo A, Moya P, Garcia-Olmo D. Int J Colorectal Dis. 2016 Sep;31(9):1625-31. doi: 10.1007/s00384-016-2621-7. Epub 2016 Jul 4. What is already known: The benefits of ERAS for patients undergoing colorectal surgery is well known. However, the benefits to specific patient groups in particular the elderly, is less well known. What this paper adds: This is a multicentre non-randomised retrospective analysis of patients over 70 years old undergoing colon or rectal surgery in three Spanish tertiary hospitals. Their ERAS programme comprised ten main elements. 188 patients over 70 underwent surgery [median 79 (70-93)]. Global compliance of the elements was a less than impressive 56% overall. Only 44% of patients underwent laparoscopic surgery; 43% of patients did not have an abdominal drain; only 64% had their urinary catheter removed promptly and 67% had epidural analgesia. However, 90% of patients underwent early mobilisation and early intake of clear fluids. Overall length of stay was 6 days. The authors found that with increasing compliance length of stay decreased, and importantly only 6.4% of patients were readmitted to hospital after discharge. The study showed that ERAS after colorectal surgery is safe and feasible, and that age is no barrier to an effective programme. Chris Jones, Guildford. @chrisnjones ### The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. Rollins KE, Javanmard-Emamghissi H, Acheson AG, Lobo DN. Ann Surg. 2019 Jul;270(1):43-58. doi: 10.1097/SLA.0000000000003145. What is already known: The use of mechanical bowel preparation (MBP) has always been an area of controversy, in fact was the subject of a fascinating pro-con debate at the ERAS Congress in Lyon. Current evidence would suggest that it does not impact on morbidity or mortality, so its routine use is not indicated. However the use of oral antibiotics (OAB) before surgery to reduce surgical site infections (SSI) has reignited that debate, or at least muddied the water. What this paper adds: This is a meta-analysis of a large number of patients undergoing elective bowel surgery. They received OAB with or without MBP. OAB + MBP showed a significant reduction in SSI, anastomotic leak, 30-day mortality, overall morbidity and development of ileus. OAB vs OAB + MBP showed no difference in SSI or anastomotic leak but did show a reduction in 30-day mortality and ileus with the combination. It would seem that OABs have a role in reducing a number of different postoperative complications, but we need more high quality evidence to say whether the OABs showed be combined with MBP or not. Chris Jones, Guildford. @chrisnjones ### Randomized Controlled Trial of Extended Perioperative Counseling in Enhanced Recovery After Colorectal Surgery. Randomized Controlled Trial of Extended Perioperative Counseling in Enhanced Recovery After Colorectal Surgery. Forsmo HM, Erichsen C, Rasdal A, Tvinnereim JM, Körner H, Pfeffer F. Dis Colon Rectum. 2018 Jun;61(6):724-732 What is already known: Preoperative education or counselling has always been an important part of a comprehensive ERAS programme. It makes a lot of sense to do it but there is limited good quality evidence for its inclusion. What this paper adds: This is the first randomized clinical trial comparing normal and extended counselling within an ERAS programme for colorectal surgery. The group with extended counselling had a higher level of adherence to the elements which resulted in a 2 day reduction in length of stay. A simple but important study highlighting the importance of a good preoperative educational programme. Chris Jones, Guildford. @chrisnjones ### Ready to Go Home? Patients' Experiences of the Discharge Process in an EnhancedRecovery After Surgery (ERAS) Program for Colorectal Surgery Ready to Go Home? Patients' Experiences of the Discharge Process in an EnhancedRecovery After Surgery (ERAS) Program for Colorectal Surgery Jones D, Musselman R, Pearsall E, McKenzie M, Huang H, McLeod RS. J Gastrointest Surg. 2017 Nov;21(11):1865-1878 What is already known: Patient involvement and their pre-operative education on what to expect whilst in hospital is an essential part of a successful ERAS programme. However this is mostly on the actual procedure / hospital stay rather than education on what to expect after discharge. This Canadian group sought to ascertain the satisfaction and major concerns patients had with their discharge planning process. What this paper adds: Generally patients were very satisfied, with 93% of patients happy with the information they received prior to discharge, and 90% felt they were ready to go home. However quite a few patients felt they needed more information on specific complications and symptoms and how to manage them at home. In particular patients who underwent stoma formations as part of their surgery. Eighty-four percent of these patients experienced problems post-operatively and over 70% needed to seek help from healthcare professionals. In particular they wanted the contact details of a stoma-nurse and felt that if they could directly discuss things with them it could reduce the need for emergency admission. Chris Jones, Guildford. @chrisnjones ### Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival? Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival? Curtis et al. Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival? Colorectal Dis. 2017 Aug;19(8):723-730. doi: 10.1111/codi.13603. What is already known: We know that perioperative complications (especially major) can negatively impact long term survival rates. We also know that ERAS protocols can improve long term survival rates. However do readmissions (which represent potential complications) have an effect on long term survival?? What this paper adds: In this large retrospective analysis of a prospectively kept database, 16% of over 1000 patients were readmitted. Gut dysfunction and wound complications were the most common cause of readmission. In this study readmission alone did not have a significant impact on 5-year overall survival. However the majority of readmissions only had minor complications on the Clavien-Dindo classification, which may have explained the lack of impact. Chris Jones, Guildford. @chrisnjones ### Prospective Evaluation of Discharge Trends after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway Prospective Evaluation of Discharge Trends after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway Slieker et al. Prospective Evaluation of Discharge Trends after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway. Dig Surg. 2017;34(4):298-304. doi: 10.1159/000452633. Epub 2016 Dec 10. What is already known: Length of hospital stay is one of the most common primary end points seen in ERAS studies. A few studies have investigated the time to being medically fit for discharge rather than hospital length of stay. However there is often a delay between being medically fit for discharge and actually going home. This study seeks to investigate the factors behind this disparity. What this paper adds: Only 30% of all patients were discharged from hospital on the same day that they met all the discharge criteria. Overall patients were discharged on average 2 days after meeting the criteria. Interestingly the main reason for this was a general feeling that the patient was being discharged too soon. For example if a patient met discharge criteria sooner than the pre-operative planned target discharge date. Other main causes were organisational and then patient being unwilling to go home. The authors felt that discharge planning should be based on meeting specific discharge criteria rather than a generic pre-planned discharge date. Chris Jones, Guildford. @chrisnjones ### The Role of Transversus Abdominis Plane Blocks in Enhanced Recovery After Surgery Pathways for Open and Laparoscopic Colorectal Surgery. The Role of Transversus Abdominis Plane Blocks in Enhanced Recovery After Surgery Pathways for Open and Laparoscopic Colorectal Surgery. Kim AJ, Yong RJ, Urman RD. J Laparoendosc. The Role of Transversus Abdominis Plane Blocks in Enhanced Recovery After Surgery Pathways for Open and Laparoscopic Colorectal Surgery. Adv Surg Tech A. 2017 Sep;27(9):909-914.  What is already known: Good analgesia, enabling patients to meet the various mobilisation and dietary goals is an essential part of a good ERAS programme. But the optimal form of analgesia is not yet known. Abdominal plane blocks such as TAP blocks are a popular choice for abdominal surgery. What this paper adds: The authors conducted a comprehensive literature review, comparing TAP blocks with other different modalities for (mostly) laparoscopic colorectal surgery, and conclude that these blocks are a useful adjunct in the multimodal analgesic plan for these patients. They are easy to perform and are opioid sparing with minimal side effects. They also suggest that liposomal bupivacaine may be more effective than conventional bupivacaine. Chris Jones, Guildford. @chrisnjones ### A Comparison of Multimodal Analgesic Approaches in Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery: Pharmacological Agents. A Comparison of Multimodal Analgesic Approaches in Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery: Pharmacological Agents. Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD. A Comparison of Multimodal Analgesic Approaches in Institutional Enhanced Recovery After Surgery Protocols for Colorectal Surgery: Pharmacological Agents. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):903-908.  What is already known: Multi-modal analgesia is probably the cornerstone of any successful ERAS pathway. The majority of people would understand exactly what it is, but anecdotally different institutions have some different approaches to this. This paper aims to compare and contrast a number of different protocols across North America and one in New Zealand. What this paper adds: The group examined a total of 15 protocols. No two were the same. Some were very prescriptive and some just described general principles. Preoperative regimens varied the most. When the same drugs were suggested, dosing also varied quite markedly. Gabapentin varied the most, with doses from 100mg up to 900mg. Intraoperatively six (out of 15) used lidocaine (either boluses or infusions); eight used Ketamine; but only two used Magnesium. Postoperatively was the most prescriptive, but again doses were quite varied. Interestingly despite the goal of multi-modal analgesia is to limit the amount of opiates dosing, three protocols used an opiate PCA as standard treatment. In this study there was definite variation in multi-modal analgesia regimens It was not possible to ascertain exactly why each approach was different. Interestingly despite the obvious greater ERAS experience no European protocols were used in the analysis. Chris Jones, Guildford. @chrisnjones. ### Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection Eriksen J et al Orthostatic intolerance in enhanced recovery laparoscopic colorectal resection. Acta Anaesthesiol Scand. 2019 Feb;63(2):171-177 What is already known: ERAS protocols have been safely implemented in colorectal surgery and include early mobilisation after surgery. Orthostatic hypotension (OH) and orthostatic intolerance (OI) are both barriers to full implementation of ERAS protocols post-operatively but their mechanism, risk factors and prevalence are not currently known. This study aimed to investigate these factors. What this paper adds: This single centre prospective observational study looked at 100 patients presenting for elective minimally invasive colorectal resections for underlying cancer. OI was present in 60% of patients in the first 24 hours postoperatively. Risk factors for development of OI at 6 hours were lower age, lower BMI and female gender. Female gender and ASA >1 were predictive of OI at 24 hours. There was no association between opioid consumption and fluid administration within the first 24 hours with the development of OI. There was a tendency for patients with OI at 24 hours to have a prolonged length of stay. This study further supports previous work showing that any barrier to adherence to the strict ERAS protocols can lead to delayed hospital discharge. Further studies should aim at looking at ways to minimise postoperative OI. Katie Wimble, Guildford ### The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery Rollins KE and Lobo, DN The Controversies of Mechanical Bowel and Oral Antibiotic Preparation in Elective Colorectal Surgery. Ann Surg 2020. DOI: 10.1097/SLA.0000000000003985 What is already known: There has long been controversy and debate in the surgical world over the benefits (or not) of using mechanical bowel prep (MBP) prior to elective colorectal surgery. Whilst the question of MBP use alone compared with no bowel prep has been answered, (there is no benefit), there has been a resurgence of interest in the use of oral antibiotic solution (OAB). The authors of this article have previously published a comprehensive meta-analysis of this subject [reviewed here], but two significant RCTs have been subsequently published and the authors sought to update this, and discuss where it leaves us. What this paper adds: The updated analysis compared OAB vs no bowel preparation and MBP + OAB vs no bowel preparation. Overall the two new RCTs did not alter the results; don’t let the headline put you off, this paper is well worth a read. The no-change was partly due to the small numbers in the studies when compared to some of the larger national databases which was used as part of the analysis (one had >30,000 patients). It brings into question the of using smaller RCT data versus “real life” larger cohort studies which the authors discuss in detail. Also the question of using MBP and OAB versus OAB alone is still unanswered. The authors point out the high heterogeneity in some of the outcomes of the meta-analysis suggests the current data are far from conclusive and so still need one big multicentre possibly multinational study to help answer this question one final time. With patients randomised into three distinct groups – no bowel prep, OAB + MPB and OAB alone. Chris Jones, Guildford. @chrisnjones. ### Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery Marcotte JH et al. Oral Versus Intravenous Acetaminophen within an Enhanced Recovery after Surgery Protocol in Colorectal Surgery. Pain Physician. 2020 Jan;23(1):57-64. What is already known: Multimodal analgesia is an essential part of a successful ERAS programme, in particular simple analgesics such as acetaminophen or paracetamol. What this paper adds: All patients underwent colorectal resection within a comprehensive ERAS programme. All had a multimodal analgesic regimen, but with the only difference being either intravenous or oral paracetamol / acetaminophen. There was no overall difference in pain scores. But the iv group received significantly less oral morphine equivalents, and were also significantly less likely to receive opioid patient controlled analgesia. However whilst the findings were interesting, this was a retrospective review performed in a single centre. It also goes against the findings of a recent meta-analysis which showed no difference between the two routes. Chris Jones, Guildford. @chrisnjones. ### The importance of high compliance with all ERAS elements. The importance of high compliance with all ERAS elements. Gustafsson U; Hausel J; Thorell A; Ljungqvist O; Soop M; Nygren J; Enhanced Recovery After Surgery Study Group. Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery. Arch Surg. 2011;146(5):571-577. What is already known: This is now a relatively old paper but it was one of the first large studies to highlight the importance of adherence to all the ERAS elements. What this paper adds: This is a large prospective cohort study from a single centre. It compared an earlier phase (2002-5) during which ERAS was poorly implemented with a more recent period (2005-7) during which the ERAS programme was reinforced and as such achieved significantly higher compliance with the protocol. They demonstrated fewer major complications, fewer debilitating postoperative symptoms and shorter length of stay. Multivariate analysis showed that preoperative carbohydrate loading and perioperative fluid restriction were independent predictors of postoperative outcomes. Chris Jones, Guildford ### ERAS and the impact of sarcopenia on outcomes ERAS and the impact of sarcopenia on outcomes Pędziwiatr M, Pisarska M, Major P, Grochowska A, Matłok M, Przęczek K, Stefura T, Budzyński A, Kłęk S. Laparoscopic colorectal cancer surgery combined with enhanced recovery aftersurgery protocol (ERAS) reduces the negative impact of sarcopenia on short-termoutcomes. Eur J Surg Oncol. 2016 Jun;42(6):779-87. What is already known: The presence of sarcopenia (loss of skeletal muscle mass) or myosteatosis (fat infiltration in skeletal muscle) can lead to increased rates of morbidity and mortality in colorectal surgery. However the majority of studies are in open surgery. What this paper adds: This study of 124 patients undergoing laparoscopic colorectal surgery demonstrated that a comprehensive ERAS program can minimise the negative impact of sarcopenia and myosteatosis on all post-operative outcomes in colorectal cancer surgery. Chris Jones, Guildford. ### Enhanced Recovery After Surgery: A Review  Enhanced Recovery After Surgery: A Review  Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surgery. Epub January 11th 2017. Comments This review, written by three members of the ERAS® executive committee, provides a great overview of how fast track or Enhanced Recovery has evolved. The rationale of ERAS® is discussed, its elements and the concept of multimodal care, with synergy between the individual elements of care, as well as the interplay between caregivers: surgeons, physicians, nurses, physiotherapists and dieticians. The paper addresses how ERAS programmes are set up in individual institutions, underpinned by evidence based, procedure specific, guidelines and continuous audit. The ERAS® Society been at the forefront of worldwide implementation of ERAS®. Whilst length of hospital stay may have been an early goal for patients treated within ERAS® programmes, we are now seeing other benefits in particular a reduction in complications and readmissions across a range of surgeries. This has resulted in considerable cost savings per patient. Excitingly, long term benefits of ERAS® are becoming evident in both orthopaedics and patients with colorectal cancer. Since this prestigious review was written for JAMA Surgery, our friend, colleague and mentor, Professor Ken Fearon died, and this review provides a fitting testimony to his outstanding efforts, intellect and enthusiasm for the ERAS® programme. Bill Fawcett, UK. ### Regional anaesthesia and ERAS Regional anaesthesia and ERAS Carli F, Clemente A. Regional anesthesia and enhanced recovery after surgery. Minerva Anestesiol. 2014 Nov;80(11):1228-33 Comments This paper written by one of the board members of the ERAS society explores the role of regional anaesthesia within an ERAS program and how it can affect postoperative outcomes. Chris Jones, Guildford. ### Risk of anastomotic leak after NSAID use within an ERAS programme Risk of anastomotic leak after NSAID use within an ERAS programme Bakker N, Deelder JD, Richir MC, Cakir H, Doodeman HJ, Schreurs WH, Houdijk AP. Risk of anastomotic leakage with nonsteroidal anti-inflammatory drugs within an enhanced recovery program. J Gastrointest Surg. 2016 Apr;20(4):776-82. What is already known: Anastomotic leakage is a much feared complication after colorectal resection. The incidence is higher in low rectal resections (up to 13%) than with colonic resections (3%). It can have a profoundly negative impact on length of stay, morbidity and mortality, and possibly on longer term oncological outcome. It is thought that NSAID’s can increase this risk. What this paper adds: In this single centre observational study the use of diclofenac was associated with a higher rate of anastomtic leakage in both colonic and rectal resections. Interestingly the other NSAIDS – Ibuprofen and Mebutan used in this study had no association. Chris Jones, Guildford. ### What are the risk factors for delayed discharge within an ERAS programme? What are the risk factors for delayed discharge within an ERAS programme? Pędziwiatr M, Pisarska M, Kisielewski M, Matłok M,Major P, Wierdak M, Budzyński A, Ljungqvist O. Is ERAS in laparoscopic surgery for colorectal cancer changing risk factors for delayed recovery? Med Oncol. 2016 Mar;33(3):25. What is already known: ERAS programmes are well known to reduce length of stay, however the reasons for a prolonged stay are not as well studied. In this Swedish pilot study which included the ERAS society chairman in its authorship, aimed to assess what influences delayed discharge within an ERAS program for laparoscopic colorectal surgery. What this paper adds: Length of stay did not seem to be affected by traditional patient risk factors eg ASA grade, co-morbidities or cancer stage but simply by compliance of the ERAS protocol. The exact reason why a patient did not follow the protocol fully remains to be answered, and may well be tricky to address but a key question to answer in the future. Chris Jones, Guildford. ### Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial. Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial. Wen Wu FM, Burkhard F, Turri F, Furrer M, Loeffel L, Thalmann G, Wuethrich P (2017) Renal outcome after radical cystectomy and urinary diversion performed with restrictive hydration and vasopressor administration in the frame of an enhanced recovery program: A follow-up study of a randomized clinical trial. Urol Oncol. 2017 Oct;35(10):602.e11-602.e17. What is already known: Radical cystectomy surgery is well known to have a prolonged length of stay and high morbidity, in particular postoperative ileus. In this groups original study looking at ERAS for open surgery with a restricted fluid regimen they demonstrated a reduction in both hospital stay and gastrointestinal complications. However, concerns were raised about postoperative renal dysfunction after using this restrictive regimen of 1ml/kg/hr in addition to a small dose of norepinephrine. What this paper adds: There has been a lot of discussion over the years about restrictive vs liberal use of fluids and whilst this is not the paper to answer those questions it does suggest that there is little difference in outcomes with the two regimens. What was interesting is that the authors used an oesophageal doppler as part of their protocol but did not seem to use it to guide fluid therapy? Which goes against most ERAS guidelines whereby the recommendation is very much towards individualised or goal directed fluid therapy. Chris Jones, Guildford. @chrisnjones ### REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial. REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial. Bakshi SG, Mapari A, Shylasree TS.REctus Sheath block for postoperative analgesia in gynecological ONcology Surgery (RESONS): a randomized-controlled trial. Anaesth. 2016 Dec;63(12):1335-1344. What is already known: Epidurals are often considered the gold standard when it comes to post-operative analgesia in open surgery. However, a lot of the evidence for this comes from the pre-ERAS era. There are also associated complications for example hypotension and muscle weakness, which can affect early mobilisation. Together with a consistent associated failure rate, this has given rise to a great deal of interest in different analgesic techniques in particular for open surgery. What this paper adds: This is a small RCT of patients undergoing an ERAS programme for open midline gynae-oncology surgery using Rectus Sheath catheters, randomised to receive either local anaesthetic or normal saline alongside a morphine PCA. Unsurprisingly the local anaesthetic group had better pain scores and had a significant morphine sparing effect. This group were also able to mobilise sooner and had an earlier return to bowel function, suggesting that rectus sheath analgesia could be an alternative analgesic modality. Although doesn't answer the question of what is the optimal analgesia for open midline surgery within a comprehensive ERAS programme. Chris Jones, Guildford. @chrisnjones ### Active and passive compliance in an enhanced recovery programme. Active and passive compliance in an enhanced recovery programme. Thorn CC, White I, Burch J, Malietzis G, Kennedy R, Jenkins JT. Int J Colorectal Dis. 2016 Jul;31(7):1329-39. doi: 10.1007/s00384-016-2588-4. Epub 2016 Apr 26. What is already known: We know that outcomes improve with increasing compliance of (all) elements. And a large number of trials have attempted to discover which individual element is the most important, so far without success. What this paper adds: This is a really interesting paper, where the authors have attempted to split the ERAS elements into active and passive ones. Active elements require patient participation (e.g. mobilising for a set distance per day); and so are more difficult to achieve than passive elements that do not require patient participation (e.g. undergoing goal directed fluid therapy). The authors defined 6 elements as active ones and 10 as passive elements. Compliance of active elements demonstrated superior discrimination of major morbidity and prolonged length of stay (LoS) compared to the passive elements. Failure to comply with these active elements could therefore be used as an early indicator of either potential morbidity or prolonged LoS, allowing for timely intervention. Chris Jones, Guildford. @chrisnjones ### Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy: Is a Reasonable Prediction of Hospital Stay Possible? Enhanced Recovery After Surgery (ERAS) Pathway in Esophagectomy: Is a Reasonable Prediction of Hospital Stay Possible? Parise et al. Ann Surg. 2019 Jul;270(1):77-83. doi: 10.1097/SLA.0000000000002775. What is already known: An oeshophagectomy is probably the surgery with the biggest surgical stress response. It has high rates of morbidity and so patients undergoing this type of operation would have the most to gain from a comprehensive ERAS pathway. The ERAS society have recently published guidelines on the perioperative care of these patients, which can be found here. A general difficulty in ERAS, is to predict which patients will fail to follow a pathway. If we could predict, then we could allocate time and resources to those who were at risk of not following the pathway. What this paper adds: The authors of this study attempted to come up with an Enhanced Recovery Predicting Score based on multivariate regression analysis of almost 300 patients who had previously followed an ERAS pathway for oesophagectomy. It included variables such as if a patients ASA score was greater than or equal to 3, if surgery lasted longer than 255 minutes, if non-hybrid surgical approaches were used and whether patients were able to meet their initial mobilisation goals. The authors then used this scoring system to a prospective cohort of patients undergoing surgery at their institution. The score had a sensitivity of 96.6% but the specificity was only 17.6%, so it may not be the definitive answer but is certainly a good start. Chris Jones, Guildford. @chrisnjones ### Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer. Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer. Pisarska et al. World J Surg. 2019 Jul 8. doi: 10.1007/s00268-019-05073-0. What is already known: The short-term benefits of ERAS are well known but what is really exciting is how the evidence of long-term benefits are slowing building. What this paper adds: This study of patients undergoing laparoscopic colorectal surgery has an impressive overall compliance of all the elements (85.2%), but when they divided the patients into 2 groups (<80% and >80% compliance) there were differences in outcomes. 3-year survival was 88% in the high compliance group compared to 76% in the lower compliance group (p=0.0007). There were also fewer complications (44 vs 23%) and shorter length of stay in the high compliance group (6 vs 4 days). This paper nicely adds to the growing evidence of improved longer-term outcomes with ERAS. Chris Jones, Guildford. @chrisnjones ### Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition). Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition). Sandrucci et al. Eur J Surg Oncol. 2018 Apr;44(4):509-514. Epub 2018 Jan 12. What is already known: Malnutrition is an important risk factor for all patients but in particular those undergoing oncological surgery. It is known to be associated with increased length of stay, increased post-op complications and mortality. What this paper adds: This is a combined statement from the ERAS Society and the European Society of Surgical Oncology (ESSO). It discusses the importance and role of a good ERAS programme, nutritional screening, prehabilitation, immunonutrients, the management of the frail and elderly, it even touches on how surgical technique could have an impact. Chris Jones, Guildford. ### Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry Braga M, Borghi F, Scatizzi M, Missana G, Guicciardi MA, Bona S, Ficari F, Maspero M, Pecorelli N; PeriOperative Italian Society. Surg Endosc. 2017 Nov;31(11):4393-4399. What is already known: A lot of studies are single centre with small patient numbers, so studies using national databases with much larger patient numbers are to be welcomed. What this paper adds: Prospectively collected data from 13 different Italian hospitals were entered in an electronic national registry. Over 700 patients were included and were divided into 3 groups. Laparoscopic surgery, conversion to open surgery and primary open surgery. They found that patients undergoing laparoscopic surgery were more likely to successfully adhere to all the elements of the ERP; and multivariate analysis showed that having laparoscopic surgery was an independent factor for successful adherence. This was despite those undergoing open surgery being generally older and had higher rates of stoma formation. Chris Jones, Guildford. @chrisnjones ### Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led study Gillis C, Gill M, Marlett N, MacKean G, GermAnn K, Gilmour L, Nelson G, Wasylak T, Nguyen S, Araujo E, Zelinsky S, Gramlich L. BMJ Open. 2017 Jun 24;7(6):e017002 What is already known: Patient centered care is perceived as the most important part of healthcare but often patients are not really involved in shaping health services. This is a really interesting and important study as it is the first patient led ERAS study. Where patients were trained to conduct experimental patient research, and to characterise the needs and expectations of patients following ERAS care. What this paper adds: The main finding from this study is that patients wish ERAS pathways included their whole journey from diagnosis to recovery, and not just be limited to the perioperative phase. The ERAS protocol should be fully explained and the purpose of it should also be reinforced. The protocol should be extended to preoperatively to help patients prepare emotionally, psychologically and physically before surgery. Peer support should be available (I happen to think this is invaluable!). And finally for clinicians to realise that one-size-does not fit all and that personalised adaptations within the standardised pathway are required. It is not the largest of studies (only 20 patients) so cannot claim to speak for all patients but it still gives valuable insight to the wants and needs of patients undergoing ERAS programmes. Chris Jones, Guildford. @chrisnjones ### The History of Enhanced Recovery After Surgery and the ERAS Society The History of Enhanced Recovery After Surgery and the ERAS Society Ljungqvist O, Young-Fadok T, Demartines N. The History of Enhanced Recovery After Surgery and the ERAS Society. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):860-862.  What is already known: The ERAS society has been incredibly influential in promoting the best possible peri-operative care and to improve recovery through research, education, audit and implementation of evidence-based practice. What this paper adds: This short historical overview explains the development of enhanced recovery from a small group of surgeons in European academic centers to the establishment of ERAS Society, now reaching all major continents and involving a wide range of surgical and anesthesia disciplines. It is well worth a read for those who wish to know more about the history of ERAS and the ERAS society. Chris Jones, Guildford. @chrisnjones ### Understanding Enhanced Recovery After Surgery Guidelines: An Introductory Approach. Understanding Enhanced Recovery After Surgery Guidelines: An Introductory Approach. Elias KM. Understanding Enhanced Recovery After Surgery Guidelines: An Introductory Approach. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):871-875.  What is already known: Whilst ERAS protocols have been around for a long time, but units new to ERAS can be put off by the complexity of having to introduce up to 30 different elements and up to 100 individual variables. What this paper adds: The author has attempted and done well to simplify the guidelines and broken them down into simple chunks as well as ensuring the work is distributed amongst the different members of the multi-disciplinary team. A good summary for someone looking to get set up a new ERAS pathway. Chris Jones, Guildford. @chrisnjones ### Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery Keil DS et al. Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery. Anesth Analg. 2019 Sep;129(3):776-783. What is already known: ERAS pathways have dramatically shortened the average length of stay in a vast number of different procedures. For some procedures like laparoscopic hysterectomy [LH] same day discharge is even possible. Same-day discharge has been associated with increased patient satisfaction, as well as decreased total hospital costs without significant increases in perioperative complications or rates of readmission/reoperation. So if one can establish which factors are predictive of admission then it is possible to focus on these to potentially improve outcomes. What this paper adds: 165 patients underwent LH within a comprehensive ERAS programme. 56% were discharged on the same-day and the rest were admitted. There were no differences in ER visits, readmissions or re-operations. The most common causes of admission were urinary retention (30%), pain (30%) and PONV (10%). Multivariable logistic regression demonstrated that ASA class, increased length of surgery and ethnicity were all found to be risk factors for being admitted postoperatively. Chris Jones, Guildford. @chrisnjones ### Staff experiences of enhanced recovery after surgery: systematic review of qualitative studies Staff experiences of enhanced recovery after surgery: systematic review of qualitative studies Cohen R, Gooberman-Hill R. Staff experiences of enhanced recovery after surgery: systematic review of qualitative studies. BMJ Open. 2019 Feb 12;9(2):e022259. What is already known: ERAS programmes are well established in a lot of centres but there have often been barriers in setting them up and ultimately their success. Barriers such resistance to change, inadequate funding, lack of support from management, high staff turnover, poor documentation and shortness of time, while facilitators included a dedicated enhanced recovery lead, effective multidisciplinary team (MDT) working and ongoing education for staff and patients. What this paper adds: In this systematic review the authors sought to explore health professionals' experiences of and perspectives on the ERAS pathways. Staff felt positive about the implementation of ERAS but found the process complex and challenging. They found that challenges could be addressed by ensuring that multidisciplinary teams understand ERAS principles and guidelines and communicate well with one another and with patients. Provision of comprehensive, coherent and locally relevant information to health professionals was helpful. Identifying and recruiting local ERAS champions is likely to improve the implementation and delivery of ERAS pathways. Chris Jones, Guildford. @chrisnjones ### Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial. Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial. Trejo-Ávila ME et al. Enhanced recovery after surgery protocol allows ambulatory laparoscopic appendectomy in uncomplicated acute appendicitis: a prospective, randomized trial. Surg Endosc. 2019 Feb;33(2):429-436.  What is already known: The vast majority of ERAS programmes are focused on purely elective surgery. This study focusses on the common emergency operation, appendicitis. What this paper adds: In this small RCT patients were randomised into 2 groups (ERAS vs standard care). With the exception for the pre-admission elements, this was a fairly comprehensive ERAS programme. They demonstrated an impressively short length of stay (a mean of only 9.7 hours to discharge, compared to 23.2 hours in the standard group). There was a reduced time to resume diet and a reduced incidence of moderate to severe pain scores postoperatively (28% vs 62%). There was no difference in complications, reoperations and importantly readmissions. Chris Jones, Guildford. @chrisnjones ### An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients N Levy et al. An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients Anaesthesia 2020 Oct 7. doi: 10.1111/anae.15262. What is already known: Opiates are an important part of pain management and especially post-surgical pain. However, there is now a global overuse of opioids, often referred to as the “opioid crisis” which as perioperative physicians we may have unwittingly contributed to. What this paper adds: This is an international multidisciplinary consensus statement (four of the authors are executive members of the ERAS Society) and was developed to provide balanced guidance on the safe peri-operative use of opioids in adults. Recommended strategies to reduce harm include: identifying those at risk pre-operatively; assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long-acting (modified release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; and providing deprescribing advice. This consensus statement provides a really useful framework for better prescribing practices that hopefully will help reduce the risk of postoperative opioid-related harm in adults. Chris Jones, Guildford. @chrisnjones ### Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Brethauer SA et al. Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis. 2019 Nov;15(11):1977-1989. doi: 10.1016/j.soard.2019.08.024. Epub 2019 Sep 23. What is already known: Baraitric surgery is the most effective treatment for morbid obesity, and large numbers of these operations are performed all around the world. These are high risk patients often with comorbidities and so an ERAS pathway is ideal for these types of patients.  However the US has been relatively slow to adopt ERAS pathways What this paper adds: This is an interesting study. It was a national quality improvement project in the US, enrolling 36 different sites, but specifically targeted sites that already had an extended length of stay (ELOS). The ENERGY (employing enhanced recovery goals for surgery) pathway used was based on the ERAS Society guidelines for Bariatric surgery (which you can find here). They allowed sites a six month run-in period, and found that with a comprehensive ERAS programme the rates of ELOS (defined as greater than 3 days) was significantly reduced – 8.1% vs 4.5% (p<0.01). There was no change in adverse events or readmissions. There was a slight trend towards high bleeding rates but did not reach significance and one thought was that it could have been the use of NSAIDs as part of a opiate sparing multimodal analgesia package. Chris Jones, Guildford. @chrisnjones ### Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital. Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital. Norman A et al. Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital. Can J Surg. 2020 May 21;63(3):E292-E298. doi: 10.1503/cjs.016018. What is already known: ERAS programmes especially for colorectal surgery have been around for a long time and can be hugely successful, especially in a trial setting. But what happens after the trial ends? What this paper adds: The community hospital in this study employed an ERAS coordinator to run things on the ward and ensured the guideline was adhered during the trial period (six months). This was successful. Adherence improved from 52% to 81%, and length of stay reduced from 7.25 days to 5.44. However once the trial finished and the ERAS coordinator left, adherence dropped and length of stay rose back to 7 days. This really highlights the importance of not relying on just one person (especially when they are not permanent members of staff). A successful ERAS programme requires buy-in from all members of the team and often needs a culture shift. So that all the elements of the pathway just become routine care rather than just elements of a trial. Whilst the sustainability aspect of this trail failed, there were some longer lasting improvements. Adherence did fall, but there was an overall rise from the original starting point (52% to 75%), and ileus rates also fell from 13.8% to 4.6%. Sustainability is so important, if things don’t work outside of a closely controlled trial setting then it will never work. Implementing a comprehensive ERAS pathway which works in the long term takes a lot of work from a lot of people, but many successful ERAS centres have shown that it is possible. Chris Jones, Guildford. @chrisnjones ### Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada Nguyen X. Thanh et al Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada Can J Surg. 2021 Feb 2020;63(6):E542-E550 | PDF Methods: We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. Results: The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. Conclusion: These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations. Chris Jones, Guildford. @chrisnjones ### Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial. Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial. Teigen NC et al Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial. Am J Obstet Gynecol. 2020 Apr;222(4):372.e1-372.e10. doi: 10.1016/j.ajog.2019.10.009. Epub 2019 Oct 26. What is already known: There have been a number of different studies on ERAS pathways for elective caesarean section, but currently none have been RCTs. Guidelines have even been produced by the ERAS society (found here). What this paper adds: This is a US study and the first RCT conducted, where patients were randomised by concealed envelope to either an ERAS protocol or standard care. It was a small, single centre study with only 121 patients. Their primary outcome was what they described as “early discharge” on post-operative day two. [I’m going to add a personal note here and say my wife who didn’t follow an ERAS pathway after her elective section went home on POD 1 both times!]. Only 8.6% of patients in the ERAS group were discharged on day 2, compared to 3.3% in the standard group (p=0.24). However when they compared the length of stay measured in hours they did find it was significantly shorter in the ERAS group. However, whilst 73.5 vs 75.5 hours was statistically significant (p=0.046), I’m not sure we can say it was particularly clinically significant. There was also no difference in postoperative morphine usage. There were a number of limitations to this study. Small patient numbers, single centre with possible cross over of patients in the post-op wards receiving the same ERAS type instructions. Chris Jones, Guildford. @chrisnjones ### A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda. A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda. Baluku M et al A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda. Anesth Analg. 2020 Mar;130(3):769-776. doi: 10.1213/ANE.0000000000004495. What is already known: This months ERAS reviews have an Obstetric theme. The other review was an RCT for elective caesarean section in a high income country. This one is the complete opposite and is an RCT for ERAS in emergency caesarean section in a resource limited setting of Uganda. What this paper adds: This is a great little study with 80 patients in each group. Patients were randomised into 2 groups. Considering it was only in patients undergoing emergency surgery, the ERAS group followed a fairly comprehensive ERAS pathway. The ERAS group had a statistically shorter length of stay (18.5 hours shorter – p<0.001). Both groups underwent spinal anaesthesia but only the ERAS group had intrathecal morphine (normal standard care for these patients was to not use it). Unsurprisingly whilst rates of severe pain were significantly reduced (0 vs 9 p=0.001), rates of pruritis were significantly increased in the ERAS / IT Morphine group (16 vs 1 p=0.023). This study nicely highlights that ERAS programmes can work for both emergency surgery and surgery in low-income countries. Chris Jones, Guildford. @chrisnjones ### Outcomes after ERAS for liver resection surgery Outcomes after ERAS for liver resection surgery Hughes MJ, Chong J, Harrison E, Wigmore S. Short-term outcomes after liver resection for malignant and benign disease in theage of ERAS. HPB (Oxford). 2016 Feb;18(2):177-82. What is already known: Predictors of postoperative morbidity have been studied at length over the years but there is less evidence for predictors of morbidity in patients undergoing ERAS programmes. What this paper adds: This is a retrospective study in a unit that is experienced in ERAS for liver surgery. In over 600 patients, using univariate and multivariate analysis, they found that only extended (liver) resection was a predictor of morbidity within an ERAS program for open liver resection surgery. Chris Jones, Guildford. ### Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection Clark CJ, Ali SM, Zaydfudim V, Jacob AK, Nagorney DM. Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection. PLoS One. 2016 Mar 7;11(3):e0150782. What is already known: There are several published studies relating to ERAS for open liver resection and a recent meta-analysis (Zhao et. al. 2017) demonstrated reduced hospital length of stay, time to first flatus and complications following implementation of an ERAS programme. What this paper adds: This retrospective observational cohort study did not demonstrate improvements in hospital length of stay or complication rates as others looking into ERAS for open liver resection have done. The study suggested that complication rates and ICU admissions were lower, albeit not statistically significant. The primary conclusion was that ERP implementation was safe in open liver resection. The study was limited to a single-surgeon and did not monitor compliance to the ERP protocol. Ben Morrison, Guildford. ### Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy Yang R, Tao W, Chen YY, Zhang BH, Tang JM, Zhong S, Chen XX. Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy: A meta-analysis. Int J Surg. 2016 Dec;36(Pt A):274-282. What is already known: Multiple published trials, including a recent meta-analysis (Song et al 2016) have highlighted the benefits of implementing ERAS programs in patients undergoing open hepatectomy. However, with an increasing number of centers now moving towards a laparoscopic approach the evidence for using such programs within this cohort is less well established. What this paper adds: This meta-analysis, which includes 8 studies (3RCT and 5CCT), showed no significant difference when applying ERAS principles to intra-operative complications including blood loss, blood transfusion requirement and intra-operative surgical time. There was however a significant improvement in post-operative recovery with a reduced time to first oral intake, flatus and a decreased post-operative stay and complication rate. Re-admission rates were not analysed due to the lack of data in the reviewed studies and variance in study protocols. Further studies may be required to determine the optimal ERAS protocol for patients undergoing a laparoscopic hepatectomy. Emma Stewart, Guildford. ### Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids. Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids. Lillemoe HA et al (2019) Enhanced recovery in liver surgery decreases postoperative outpatient use of opioids. Surgery. May 15. pii: S0039-6060(19)30074-1.  What is already known? The opioid epidemic, as it has come to be known, is a worsening global crisis. The problem appears to largely stem from high rates of opioid prescriptions and patients stockpiling and passing-on prescribed opioids to other users both of which conspire towards addiction. One of the main principles of ERAS is that if multi-modal analgesia equating to opioid-sparing. Many studies have shown a reduction in the use of opioids in the immediate perioperative period in patients enrolled on an ERAS programme. There is currently no evidence that this has translated into a reduction in opioid use post-hospital discharge. There is, in fact, a suggestion that the opposite may be true in view of patients on ERAS programmes leaving hospital earlier with higher analgesia requirements at the point of discharge. What this paper adds: The authors believe this to be the first paper looking at post-discharge prescriptions and use of opioids at the first follow-up appointment for patients having undergone major oncological surgery – namely liver resection surgery. The paper demonstrates a startling reduction in prescriptions for “traditional” opioids in patients following an ERAS pathway (26% versus 79% in patients following standard care). By the first follow-up appointment significantly fewer patients in the ERAS group were taking “traditional” opioids. Both groups, however, reported similar pain scores at this stage of their treatment. The authors point out that the dramatic reduction in opioid prescriptions results in far fewer opioid pills being potentially available in the community to pass-on to other users. ERAS patients were more likely to be prescribed tramadol (a non-“traditional” opioid with comparatively little addictive potential). This, in turn, meant they were substantially less likely to require more addictive opioids, if any opioids at all, by first follow-up. This paper demonstrates the importance of continuing the principles of ERAS beyond the immediate post-operative period and the potential public health improvements this can lead to. Ben Morrison, Guildford ### Minor laparoscopic liver resection: toward 1-day surgery? Minor laparoscopic liver resection: toward 1-day surgery? de'Angelis N, Menahem B, Compagnon P, Merle JC, Brunetti F, Luciani A, Cherqui D, Laurent A. Surg Endosc. 2017 Nov;31(11):4458-4465 What is already known: Twenty-four hour stays have been reported in specialities such as colorectal, robotic gynaecology surgery and even robotic prostate surgery. Liver surgery however has traditionally always been performed as open surgery, with prolonged lengths of stay and high potential for morbidity. But as laparoscopic techniques improve then that perception can and will change. What this paper adds: This was a small French cohort study of 24 patients undergoing minor (<3 segments) Laparoscopic Liver Resection. They all followed a comprehensive ERAS programme with a standardised anaesthetic and analgesic protocol. All were discharged on post-operative day one, less than 24 hours post-op. There were no complications, although there was 1 readmission (4.2%) who required antibiotics for a wound abscess. Demonstrating that even for potentially high-risk surgery, day stay is possible. Chris Jones, Guildford. @chrisnjones  ### Effects of multimodal fast-track surgery on liver transplantation outcomes Effects of multimodal fast-track surgery on liver transplantation outcomes Rao JH, Zhang F, Lu H, Dai XZ, Zhang CY, Qian XF, Wang XH, Lu L. Hepatobiliary Pancreat Dis Int. 2017 Aug 15;16(4):364-369 What is already known: Originally starting with colorectal surgery, ERAS protocols now exist for a huge number of different specialities and procedures. Liver transplantation is one the latest to be added to this list. What this paper adds: ERAS society guidelines currently don’t exist for liver transplantation, so the authors wrote their own. They stuck to the essential elements of preoperative education, minimising hypothermia, avoiding surgical drains, early extubation, early mobilisation and early enteral nutrition. The authors conducted a single-blinded randomised controlled trial. It is unclear who exactly is blinded but there is a suggestion it could be the patient. 128 patients were randomised over a two year period, into their new fast-tract protocol or their normal standard care. They demonstrated an impressive reduction in their ICU length of stay and hospital length of stay (5 days to 2 days, and from 28 days to 18 days). However there were no difference in complications, readmissions or mortality. Suggesting that at the very least an ERAS pathway for liver transplantation is feasible and safe. Chris Jones, Guildford. @chrisnjones  ### Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy? Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy? Lillemoe HA et al. Detours on the Road to Recovery: What Factors Delay Readiness to Return to Intended Oncologic Therapy (RIOT) After Liver Resection for Malignancy? J Gastrointest Surg. 2019 Dec;23(12):2362-2371. What is already known: For oncological surgery one of the main goals is to get the patient back to their intended oncological therapy as soon as possible after their surgery. With improved recovery times, ERAS has had a huge impact on allowing patients to receive their treatment far sooner than previously. Delays in getting this treatment will invariably have impacts on longer term outcomes. What this paper adds: This was a data trawl of a prospective database looking at patients undergoing liver resection for malignancy and looking at the determining factors between patients who underwent early vs late return to intended oncological treatment (RIOT). Univariate analysis and multivariable logistic regression were performed. It was a small study, 114 patients in total and only 32 had a delayed RIOT. Patients with a high symptom burden (measured by the MD Anderson Symptom Inventory) were most likely to have delayed RIOT. Open surgery and perhaps not unsurprisingly a post-op complication were also associated with delayed RIOT. This study can help physicians identify the patients who may need that extra bit of help in the postoperative period, and try to minimise the delay for RIOT. Chris Jones, Guildford. @chrisnjones  ### Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference? ERAS for Head and Neck Surgery Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference? Bater M, King W, Teare J, D'Souza J.Enhanced recovery in patients having free tissue transfer for head and neck cancer: does it make a difference? Br J Oral Maxillofac Surg. 2017 Dec;55(10):1024-1029 What is already known: Head and neck surgery is one of the newest specialities to embrace ERAS, but at present there are very few studies published in this area. Despite this the ERAS society have published consensus guidelines available here, based mostly on extrapolation from other surgical specialities. What this paper adds: This is one of the first papers to specifically describe an ERAS programme for head and neck surgery and compare it to a traditional care model. They compared 100 consecutive patients undergoing their ERAS programme and compared with 40 from a historical control group. Overall they demonstrated a 4 day reduction in length of stay (10 vs 14 days, p=0.003), with no change in morbidity or readmission rates. Suggesting that ERAS is safe and effective for this group of patients. Chris Jones, Guildford. ### Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes? ERAS in Emergency Surgery Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes? Quiney N, Aggarwal G, Scott M, Dickinson M (2016)Survival After Emergency General Surgery: What can We Learn from Enhanced Recovery Programmes? World J Surg. 2016 Jun;40(6):1283-7  What is already known: Emergency general surgical operations carry a very high mortality rate, and it is estimated that they are at least ten times higher than many similar elective procedures. Roughly 55,000 emergency operations are carried out each year and it is estimated that will result in 8,000 deaths. What this paper adds: In this interesting paper the authors examine the evidence behind the ERAS elements and how they can be applied to emergency surgery. In particular they examine the delays can affect outcomes, in particular delays in diagnosis, resuscitation, antibiotics and definitive care. They also examine how inadequate postoperative care can affect outcomes. Chris Jones, Guildford. ### Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients. ERAS in Emergency Surgery Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients. Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients (2016) Wisely JC, Barclay KL. ANZ J Surg. 2016 Nov;86(11):883-888. What is already known: The majority of ERAS research has been focussed, quite rightly, on improving outcomes in elective surgery. However emergency surgery has high rates of morbidity and mortality and a lot more interest more recently has been directed at how ERAS elements could affect outcomes in this high-risk group. What this paper adds: In this retrospective review the authors compared 2 groups of patients undergoing emergency major abdominal surgery before and after an ERAS program had been introduced for their elective colorectal surgery patients. A total of 370 patients were included. The two groups were similar in age, co-morbidities and ASA scores. The post-ERAS group underwent significantly more left sided procedures. Hospital length of stay was similar in both groups [median 8 days], but the post-ERAS group received significantly less intravenous fluid, both intra-operatively and post-operatively. Significantly fewer patients in the post-ERAS group had a urinary catheter or PCA for more than 2 days. There were also fewer abdominal drains used in the post-ERAS group. This resulted in significantly reduced major post-operative complications in particular chest infections. Suggesting that ERAS elements could have a place in both elective and emergency surgery. Chris Jones, Guildford. ### Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs. Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs. Schmidt HM, El Lakis MA, Markar SR, Hubka M, Low DE. Accelerated Recovery Within Standardized Recovery Pathways After Esophagectomy: A Prospective Cohort Study Assessing the Effects of Early Discharge on Outcomes, Readmissions, Patient Satisfaction, and Costs. The Annals of Thoracic Surgery. 2016;102(3):931-9 What is already known: Oesophagectomy is high risk and complex surgery, and has been associated with significant impact in terms of morbidity and mortality in the past. The introduction of enhanced recovery programmes has dramatically improved outcomes in this high risk group, including post-op complications, first-day mobilisation, and length of stay in both critical care and hospital. What this paper adds: This prospective cohort study from Virgina Mason MC, Seattle, is based on previously published outcome data of patients in their institution that identified a subgroup of patients that exceeded their day-7 discharge goal. The study attempts to identify these patients capable of achieving 'accelerated recovery' (AR), as well as assessing outcomes in this group compared to those in 'targeted recovery' (TR) and 'delayed recovery' (DR) groups (defined as those with discharge days of 5 or 6 (AR), 7 or 8 (TR) and 9 or more (DR). They found that AR patients made up 46% of their cohort, and were younger, more likely to have neoadjuvant chemotherapy, shorter operations, and less blood loss. All groups were comparable regarding comorbidities, cancer stage, and treatment approach, while DR patients were more likely to have complications. AR patients were more likely to be discharged home, with comparable 30-day readmission rates between groups. Overall costs (mean and readmission) were lower in the AR group. It is exciting to see evidence that (already impressive) lengths of stay may be further improved in a significant subset of patients undergoing oesophagectomy, with associated decreased treatment costs. The authors conclude that ERAS programs should be designed to accommodate patients appropriate for AR. The question may be, given that a number of the variables associated with 'accelerated recovery' are intraoperative (though length of surgery and blood loss may be predicted to some extent), how these findings might best be translating to service provision and planned stays in hospital in this group. Tom Barnes, East Surrey Hospital @TomBarn75870085 ### Optimising recovery after surgery: Predictors of early discharge and hospital readmission Optimising recovery after surgery: Predictors of early discharge and hospital readmission Carter J, Philip S, Wan KM. Optimising recovery after surgery: Predictors of early discharge and hospital readmission. Aust NZ J Obstet Gynaecol. 2016 Oct;56(5):489-495. What is already known: ERAS programmes have been consistently shown to reduce length of stay and post-operative complications. Minimally invasive surgery has largely become the gold standard, but laparotomies are still the mainstay in certain gynaecological cases. This large audit of 550 patients conducted over 7 years comprised all laparotomies for suspected or confirmed gynaecological malignancy in a single centre in Australia. What this paper adds: Since the introduction of their fast track surgery (FTS) programme they have shown an overall reduction in adverse events. Ultra-early discharges (on or before day 2) tended to be younger, have benign pathology, performance status 0 and a transverse incision. They report that factors associated with delayed discharge beyond day 3 were age, pathology, performance status, incision type, operating time, blood transfusion and COX-2 inhibitors. Unsurprisingly hospital readmissions were associated with longer operating times, lymph node sampling, longer length of stay, wound infections, febrile morbidity, returns to theatre, unplanned ICU admissions and presence of other complications. Their full ERAS protocol was not published. This paper highlights that despite adherence to an ERAS protocol, the unmodifiable factors of baseline demographics and disease severity have a significant impact on length of stay and adverse events. ERAS protocols should therefore be encouraged in benign gynaecological laparotomies. Katie Wimble, Guildford. @wimble_katie ### International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery Wijk L et al. (2019) International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery. Am J Obstet Gynecol. 2019 Apr 30. What is already known: The ERAS society have published guidelines on best perioperative care for a number of different specialities for a number of years now. Whilst these have always been produced using the best available evidence they have as yet never been externally validated. Evidence is also emerging that with increasing compliance of all the ERAS elements, outcomes will also improve (both short and long-term). What this paper adds: This is a hugely important paper. It is the first time a set of ERAS guidelines have been validated. The study group consisted of ten hospitals throughout North America and Europe. Data from over 2000 patients was uploaded via the web-based ERAS Interactive Audit System. They demonstrated an association between increasing compliance with the elements and a shorter length of stay. In addition the risk of having a complication was also lower with increasing compliance, again reinforcing the importance of good compliance. Chris Jones, Guildford ### Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center.  Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center.  Lambaudie E et al (2017)Enhanced recovery after surgery program in Gynaecologic Oncological surgery in a minimally invasive techniques expert center. BMC Surg. 2017 Dec 28;17(1):136. What is already known: Minimally invasive surgery is an important part of any comprehensive ERAS programme, but it is obviously not the only element. This single centre retrospective analysis of how the introduction of an ERAS pathway affected length of stay, morbidity and readmissions in their institution. What this paper adds: This paper shows that even in a high-volume centre, already used to performing minimally invasive surgery, a comprehensive ERAS pathway can still improve length of stay. Although in this study there was no effect on rates of morbidity or readmission. Chris Jones, Guildford ### Enhancing recovery after minimally invasive repair of pectus excavatum Enhancing recovery after minimally invasive repair of pectus excavatum Litz CN et al. (2017) Enhancing recovery after minimally invasive repair of pectus excavatum. Pediatr Surg Int. Oct;33(10):1123-1129.  What is already known: Paediatrics is one of the newest specialities to embrace ERAS, and so currently the evidence bas is relatively sparse. That said a number of guidelines have been published and the 1st World Congress on ERAS for Paediatrics took place last year. What this paper adds: A comprehensive ERAS programme was introduced for patients undergoing minimally invasive repair of pectus excavatum and was compared to a retrospective control group. Length of stay was reduced together with a reduction in ICU stay, a reduction in morphine usage and a reduced urinary catherization rates. Chris Jones, Guildford. ### Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding Phillips et al. Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding. J Pediatr Surg. 2019 Nov 15. pii: S0022-3468(19)30718-3. doi: 10.1016/j.jpedsurg.2019.09.065.  What is already known: There has been a drive to develop ERAS pathways for paediatric care with several institutions and groups offering publications which are largely variations on existing adult guidelines. Many previous studies on the efficacy of ERAS in paediatric surgery have focussed on laparoscopic surgery and shown benefits in reduced hospital length of stay, length of time to restoration of bowel function and opioid consumption. What this paper adds: This single-institution, retrospective study describes its development and implementation of an ERAS guideline for paediatric open and laparoscopic inflammatory bowel surgery. From an initial adult pathway of 21 elements they selected 15 for inclusion in their paediatric study. The ERAS cohort were significantly more likely to receive regional blockade and required less opioid postoperatively along with a significantly shorter time to oral fluid intake. Postoperative complications were no different to the standard care group. The results of this study are encouraging in showing that elements of adult ERAS pathways are translatable to paediatrics with effective results. Reduced opioid consumption is also particularly reassuring in light of the potential for harm in using opioids in the paediatric population. Ben Morrison, Guildford @blouism ### Nutrition in peri-operative esophageal cancer management Nutrition in peri-operative esophageal cancer management Steenhagen E, van Vulpen JK, van Hillegersberg R, May AM, Siersema. Nutrition in peri-operative esophageal cancer management. Expert Rev Gastroenterol Hepatol. 2017 Jul;11(7):663-672. What is already known: Nutrition is an essential part of a successful ERAS pathway. For oesophageal cancer patients malnutrition is especially common, so this is an even more important aspect for these patients. What this paper adds: This review explores the current literature on nutrition in the pre-, peri- and post-operative phases of the management of oesophageal cancer as part of an ERAS pathway. Chris Jones, Guildford. ### Enhanced Recovery Minimizes Opioid Use and Hospital Stay for Patients Undergoing  Mastectomy with Reconstruction. Enhanced Recovery Minimizes Opioid Use and Hospital Stay for Patients Undergoing  Mastectomy with Reconstruction. McGugin et al. Enhanced Recovery Minimizes Opioid Use and Hospital Stay for Patients Undergoing Mastectomy with Reconstruction. Ann Surg Oncol. 2019 Oct;26(11):3464-3471. What is already known: With the current opioid crisis and possible association with cancer recurrence plus all the other known side effects of their use, reducing the amount of opioids used perioperatively can only be beneficial. What this paper adds: In this study the authors conduct a retrospective observational cohort study. They compared a contemporary group with a historical pre-ERAS cohort group. All patients received a paravertebral block as part of their analgesic plan. Compared with the historical cohort, the patients undergoing mastectomy in the contemporary cohort were 26% less likely to require IV opioids and had a significantly decreased LOS. Even after adjustment for increasing rates of Nipple-Sparing Mastectomy and direct implant reconstruction over time, opioid use and LOS still were associated with the ERAS group and multimodal analgesia use. Chris Jones, Guildford. ### Enhanced recovery after surgery in paediatrics: a review of the literature Enhanced recovery after surgery in paediatrics: a review of the literature K. Roberts et al. Enhanced recovery after surgery in paediatrics: a review of the literature. BJA Education VOLUME 20, ISSUE 7, P235-241, JULY 01, 2020 What is already known: The success of adult ERAS protocols has led to interest in creating paediatric ERAS pathways. Which has led to a great deal of interest in this area, culminating in the first World Congress for Paeds ERAS in 2018. Previous literature reviews on paediatric ERAS have identified a lack of prospective and randomised control trials in this area and have acknowledged that the creation and implementation of paediatric ERAS pathways has been slower than in adults. Adult and paediatric pathways obviously share many of the key ERAS principles. These include elements such as: preoperative education, reduced preoperative fasting, minimally invasive surgical techniques, multimodal opioid sparing analgesia including regional anaesthesia, minimising the use of surgical drains and early postoperative feeding and mobilisation. What this paper adds: Although robust, high-quality evidence is lacking, the available literature demonstrates reduced length of stay, use of opioids and intraoperative fluids, and time to restarting a regular diet with paediatric ERAS protocols. This excellent review also discusses the key differences between adult and paediatric pathways and highlight other aspects such as physiological considerations based on a child’s developmental age. They also discuss the future directions for paediatric ERAS. Chris Jones, Guildford. ### Understanding the benefits and implications of Enhanced Recovery After Surgery Understanding the benefits and implications of Enhanced Recovery After Surgery Balfour A (2019) Understanding the benefits and implications of Enhanced Recovery After Surgery. Nursing Standard.  What is already known: Enhanced recovery is a true multidisciplinary endeavour, but at times the focus can be too much on the medical side of things. What this paper adds: This excellent review gives a great overview of ERAS, focusing in particular on the nursing view and how they can be empowered rather than burdened by the pathways. It looks at the barriers to implementing ERAS, such as high patient to nursing ratios on wards and so limited time to help with mobilisation goals etc. But also shows how with increasing compliance with ERAS elements it can actually decrease nursing workload. Chris Jones, Guildford. ### Implementing Enhanced Recovery After Surgery (ERAS) Program on a Specialty Nursing Unit. Implementing Enhanced Recovery After Surgery (ERAS) Program on a Specialty Nursing Unit. Tezber et al. The Journal of Nursing Administration. 48(6):303–309, JUNE 2018 What is already known: There are a lot of papers about new ERAS programmes being set up. This paper gives a lot of background to how this unit went about using their own patient outcome data to help set it up. What this paper adds: A really interesting paper talking through how this US institution set up their specialist HPB nursing unit, after root cause analysis identified a number of key reasons as to why their pancreaticoduodenectomy patients were staying longer than expected. The speciality unit, with dedicated trained staff also included ICU level care. Six months after setting up the unit an ERAS programme was designed and then fully implemented a year later. One of the interesting parts of this programme was an activity tracker that patients wore. A baseline level was measured preoperatively and then monitored up to 60 days post-op, and if the levels fall the ERAS specialist nurses can investigate the cause. The authors showed a good level of compliance with the ERAS elements, and with that a reduced hospital length of stay, reduced readmission rates and reduced costs. Chris Jones, Guildford. ### Enhanced recovery after surgery: An opportunity to improve fractured neck of femur management Enhanced recovery after surgery: An opportunity to improve fractured neck of femur management Wainwright TW, Immins T, Middleton (2016) Enhanced recovery after surgery: An opportunity to improve fractured neck of femur management. Ann R Coll Surg Engl. 2016 Sep;98(7):500-6. What is already known: Up until now the focus of ERAS has been elective surgery but there is increasing interest in applying the principles to emergency surgery. Fractured neck of femurs are a particularly high risk group of patients, and annual hospital costs are over a billion pounds per year to the NHS. What this paper adds: This study looks at Hospital Episode Statistics from 137 different hospitals and examined length of stay and how when case-mixed was adjusted data suggested that this is due to differences in practice, ie local processes and pathways rather than the nature of the patients treated. The authors suggest that the principles of ERAS could be used to improve the perioperative care of this patient group. Chris Jones, Guildford. ### The effect of peri-operative analgesia technique on outcomes following total knee arthroplasty. The effect of peri-operative analgesia technique on outcomes following total knee arthroplasty. McDonald DA, Deakin AH, Ellis BM, Robb Y, Howe TE, Kinninmonth AW, Scott NB. The technique of delivery of peri-operative analgesia does not affect the rehabilitation or outcomes following total knee arthroplasty. Bone Joint J. 2016 Sep;98-B(9):1189-96. What is already known: The introduction of ERAS programs in patient’s undergoing total knee arthroplasty have been shown to significantly reduce perioperative morbidity and mortality. During the implementation of these programs however, multiple aspects of perioperative care are altered simultaneously making it difficult to ascertain which components of the program are most important in achieving optimal outcomes. What this paper adds: This study was a non-blinded single-center randomised controlled trial comparing the outcomes of patient controlled epidural anaesthesia (PCEA) vs local anaesthetic infiltration (LAI) in total knee arthroplasty within an already established ERAS program. There were no significant differences between the two groups. Variables analysed included length of stay, range of knee movement, additional analgesia requirements, nausea, time to discharge and one year follow up. This is one of the first trials to look at using epidurals without a background infusion; this technique appears to allow safe mobilization to occur earlier than has been seen in other trials where delayed mobilization following epidurals has often been a concern. Emma Stewart, Guildford. ### Improving resource utilisation and outcomes after total knee arthroplasty through technology-enabled patient engagement. Improving resource utilisation and outcomes after total knee arthroplasty through technology-enabled patient engagement. Higgins et al. Improving resource utilisation and outcomes after total knee arthroplasty through technology-enabled patient engagement. Knee. 2019 Nov 22. pii: S0968-0160(19)30232-7.  What is already known: Pre-operative preparation of the patient is a vital aspect of a successful ERAS pathway with education being a crucial component. Improved pre-operative patient education can, independently, improve post-operative outcomes. What this paper adds: The authors describe the introduction of a digital platform available to patients having total knee arthroplasty as part of a pre-existing ERAS programme. This included general information on health and wellbeing, online contact system for patients to interact with their care provider, exercise videos and a joint school delivered by occupational therapists and physiotherapists. The group found improved outcomes in the intervention group with a reduced length of stay, reduced reoperation rate and improved PROMs including ED-5D index and EQ VAS scores. This study strongly suggests that the use of additional platforms and engaging with technology enables patients to better prepare themselves for surgery thus improving outcomes. Ben Morrison, Guildford @blouism ### Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man" Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man" Garriga C et al. Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man". Osteoarthritis Cartilage. 2019 Sep;27(9):1280-1293.  What is already known: ERAS pathways have consistently shown improvements in outcomes in a wide variety of specialities. However the majority of these studies have been small single centre ones. There are few national studies, a notable exception being Denmark, and this is one of the first looking at NHS data in England, Wales, Northern Ireland and the Isle of Man. What this paper adds: This was a national study looking at Total Knee Replacements, using the National Joint Registry and Hospital Episode Statistics. They compared three time periods, pre-intervention (2008-9), during (2009-2011) and post (2012-2016). Almost 500,000 patients were included. Overall length of stay reduced from 5.8 to 3.7 days. Bed-day costs also improved from £7607 to £5276. Complications were also reduced from 4.1% to 1.7%, and PROMS data also were improved (Oxford Knee Score). Some might argue that these data were on a gradual decline anyway and ERAS didn’t have a big impact on these improvements. This study does not confirm whether there was widespread adoption on ERAS in all centres, and so it is difficult draw complete conclusions as to the national effect of ERAS implementation. Chris Jones, Guildford. ### Enhanced Recovery Pathways in Pancreatic Surgery Enhanced Recovery Pathways in Pancreatic Surgery Barton JG. Enhanced Recovery Pathways in Pancreatic Surgery. Surg Clin North Am. 2016 Dec;96(6):1301-1312. What is already known: Mortality in pancreatic surgery has improved dramatically over the past number of years, from 25% in the 1970’s to only 2% in high-volume centres. Morbidity however remains in excess of 40%. The ERAS society has produced guidelines for pancreatic surgery in 2012, which can be found here. What this paper adds: This is a really good overview of ERAS for pancreatic surgery, with both a literature review and a more detailed look at some of the specific pancreatic elements. These include: pre-operative biliary drainage, use of intra-abdominal drains post-op, somatostatin analogues and different analgesic regimens. The author also gives a detailed day to day run through of his own institutional ERAS programme. Chris Jones, Guildford. ### The economics of recovery after pancreatic surgery: detailed cost minimization analysis of an enhanced recovery program. The economics of recovery after pancreatic surgery: detailed cost minimization analysis of an enhanced recovery program. HPB (Oxford). 2017 Nov;19(11):1026-1033.  What is already known: There have been quite a few successful published programmes for pancreatic surgery as well as published ERAS guidelines. But less is known about the economic benefits of these programmes. What this paper adds: This was a Canadian retrospective cost minimization analysis of patients undergoing pancreaticoduodenectomy with an ERAS programme versus standard care. Despite only a small reduction in total length of stay (10 vs 11 days, p=0.003), there was a pretty impressive cost saving of over 13,000 Canadian dollars per patient (including readmissions, $16,627 vs $29,872, p=0.016). The main areas of cost savings were through reducing unnecessary laboratory tests and imaging investigations. Showing nicely that it is not just reducing bed-days that saves money. Chris Jones, Guildford. @chrisnjones ### Continuous wound infiltration versus epidural analgesia after hepato-pancreato-biliary surgery (POP-UP): a randomised controlled, open-label, non-inferiority trial Continuous wound infiltration versus epidural analgesia after hepato-pancreato-biliary surgery (POP-UP): a randomised controlled, open-label, non-inferiority trial Mungroop TH, Veelo DP, Busch OR, van Dieren S, van Gulik TM, Karsten TM, de Castro SM, Godfried MB, Thiel B, Hollmann MW, Lirk P, Besselink MG. Lancet Gastroenterol Hepatol. 2016 Oct;1(2):105-113 What is already known: Epidural analgesia has always been considered the “gold-standard” but slowly that is being questioned. Also the majority of studies with pain as their main outcome, use simple visual analogue scores (VAS)to differentiate the modalities. Importantly however, this is one of the first to include patient reported outcomes as well as VAS. What this paper adds: The authors used a validated scoring system called the OBAS score (Overall Benefit of Analgesia Score). It is a validated composite score including analgesia side-effects and patient satisfaction, as well as VAS scores. They compared epidural analgesia with continuous infusions of local anaesthetic via a wound catheter in patients undergoing various different types of open hepato-pancreato-biliary surgery (mostly pancreatoduodenectomy (35% followed by liver resection (18%)). The authors set out to show that it the wound catheter was not inferior to epidural which they duly did. Vasopressor use was much lower in the wound catheter group. Adding to the growing body of evidence that an epidural is not the only option for major open abdominal surgery. Chris Jones, Guildford. @chrisnjones ### Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative  Factors and Impact. Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative  Factors and Impact. Tankel J et al. Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative Factors and Impact. Surg Res. 2020 Jan;245:569-576. What is already known: ERAS for pancreaticoduodenectomy has been around for a while. The ERAS society first published guidelines in 2012 and then updated in 2019 [they can be found here]. However, these procedures still have a high morbidity and despite the best efforts of both clinicians and patients, there will be some patients who will either deviate from the ERAS protocol or fail ERAS’ key goals. The key is to predict which ones. What this paper adds: Interestingly there was no discernible relationship between ERAS protocol deviation and failure. There was also no relationship noted between protocol deviation and serious complications or pancreatic fistula. Univariate and multivariate analyses identified variables associated with protocol deviation and failure. On univariate analysis: protocol deviation was associated with male gender, prolonged surgery time (>270 min) and prolonged Length of Stay. On multivariate analysis only prolonged LoS remained significant. Perhaps this is obvious? It stands to reason that if there are deviations from protocol then this would be associated with prolonged LoS. It suggests that perhaps deviation does not alter the course of those destined to ultimately fail to achieve the ERAS protocol goals. The next step is to accurately predict complications. The holy grail? Chris Jones, Guildford. ### Preoperative Nutrition and Prehabilitation Preoperative Nutrition and Prehabilitation Gupta R, Gan TJ. Preoperative Nutrition and Prehabilitation. Anesthesiol Clin. 2016 Mar;34(1):143-53. What is already known: Preoperative nutrition and prehabilitation are two potentially important interventions in preparing patients for surgery. What this paper adds: Comprehensive review on preoperative nutrition – including assessment and optimisation, immunonutrition and how to avoid insulin resistance. And prehabilitation – including assessment (e.g. cardiopulmonary exercise tests and 6-minute walk tests) and exercise programs. Chris Jones, Guildford. ### Prehabilitation for the Enhanced Recovery After Surgery Patient Prehabilitation for the Enhanced Recovery After Surgery Patient Shanahan JL, Leissner KB. Prehabilitation for the Enhanced Recovery After Surgery Patient. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):880-882. What is already known: The preoperative preparation of the surgical patient is a key part of a successful ERAS programme. Prehabilitation follows on from this by trying to improve the functional status of a patient by a series of interventions including exercise. What this paper adds: This is an interesting review of prehabiliation and the benefits thereof. But not just exercise programmes but also nutritional optimisation, anaemia and diabetes optimisation, and finally smoking and alcohol cessation. Chris Jones, Guildford. @chrisnjones ### Turning ‘waiting lists’ for elective surgery into ‘preparation lists’ Turning ‘waiting lists’ for elective surgery into ‘preparation lists Levy N et al. Turning ‘waiting lists’ for elective surgery into ‘preparation lists’. BJA. 2020. DOI: 10.1016/j.bja.2020.08.021 What is already known: Waiting lists for elective surgical procedures are a feature of centrally-funded healthcare systems. The global population is ageing and there is increasing associated comorbidity producing an increasing requirement for healthcare and surgical procedures. Overall the number of patients on waiting lists is set to continue growing. Large surgical waiting lists can have wide-ranging negative effects including the impact on the individuals’ physical and mental health, the impact on society – healthcare, economic, social and political and the increased pressure on health and social care workers. The preoperative phase represents a valuable window of opportunity to optimise chronic comorbidities, improve physical health and psychologically prepare an individual for surgery. This approach has been shown to improve patient outcomes and satisfaction following surgery and is a key tenet of ERAS pathways. What this paper adds: This interesting and thought-provoking editorial highlights the potential benefits of making a conceptual change as to how we as a society approach elective surgical waiting lists. The authors explain in a logical and systematic fashion the rationale for moving from a passive situation where ‘waiting lists’ are viewed negatively as time spent in stasis with a debilitating health condition to a proactive approach where ‘preparation lists’ are viewed as an opportunity to address comorbidities, improve physical health and psychologically prepare patients for their surgery. The potential benefits of making this change are enormous, encompassing positive impacts on patient outcomes and experience as well as on society as a whole. Dr Leigh Kelliher, Royal Surrey County Hospital NHS Foundation Trust, UK. ### Enhanced Recovery in a Minimally Invasive Thoracic Surgery Program Enhanced Recovery in a Minimally Invasive Thoracic Surgery Program Schatz C. Enhanced Recovery in a Minimally Invasive Thoracic Surgery Program. AORN J. 2015 Nov;102(5):482-92. What is already known: ERAS for thoracic surgery is relatively new with limited amount of research in this area. What this paper adds: The author is a nurse at Inova Fairfax Hospital in Virginia and describes how their institution set up their ERAS program. There is a strong emphasis on the nursing perspective, but readers from all disciplines would benefit from reading this review. She discusses the barriers they faced when starting the program and also reports clinical outcomes as well as patient reported outcomes including satisfaction. Chris Jones, Guildford. ### Radical Cystectomy and GI complications Radical Cystectomy and GI complications Djaladat H, Daneshmand S. Gastrointestinal Complications in Patients Who Undergo Radical Cystectomy withEnhanced Recovery Protocol. Curr Urol Rep. 2016 Jul;17(7):50. What is already known: Gastro-intestinal complications are the most frequent after radical cystectomy – up to 30% of patients will experience major GI complications (including severe post-operative ileus requiring a nasogastric tube). This study is a review of how ERAS programs can affect GI complications after radical cystectomy. You can view the ERAS guidelines for cystectomy here. What this paper adds: The authors report an impressively low rate of severe post-operative ileus (6%), with a comprehensive ERAS program as well as the regular use of prokinetics and peripherally acting mu-opioid receptor antagonists. The authors also conduct a review of the pathophysiology and management of the common GI complications – post-operative ileus, nausea and vomiting. Chris Jones, Guildford. ### ERAS for robotic assisted radical cystectomy surgery ERAS for robotic assisted radical cystectomy surgery Collins JW, Adding C, Hosseini A, Nyberg T, Pini G, Dey L, Wiklund PN. Introducing an enhanced recovery programme to an established totally intracorporeal robot-assisted radical cystectomy service. Scand J Urol. 2016;50(1):39-46. What is already known: Radical cystectomy is a high risk procedure, with high morbidity and high readmission rates. The ERAS society have previously published guidelines for this procedure (link). What this paper adds: The authors from the Karolinska Institute in Sweden describe the effects of starting a comprehensive ERAS programme in an already established centre for robotic assisted radical cystectomy. Despite the average age and ASA grade increasing they still showed a small but statistically significant reduction in length of stay (9 to 8 days), however there was no difference in 30 day complication or readmission rates. Chris Jones, Guildford. ### Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study JE. Baack Kukreja, M Kiernan, B Schempp, A Siebert, A Hontar, B Nelson, J Dolan, K Noyes, A Dozier, A Ghazi, HH. Rashid, G Wu, EM. Messing. Quality Improvement in Cystectomy Care with Enhanced Recovery (QUICCER) study. British Journal of Urology International Volume 119, Issue 1. January 2017 Pages 38-49 What is already known: Radical cystectomy is on paper one of the surgeries most suited to benefit from a comprehensive ERAS programme - elderly population, long lengths of hospital stay and high morbidity rates. Despite this uptake of ERAS programmes have been slow. What this paper adds: This US study analysed sequential patents before and after the introduction of an ERAS protocol in their institution using a propensity matched approach. They used a comprehensive ERAS programme including pre-operative counselling focusing on stoma care and discharge planning, carbohydrate loading and probiotics; intraoperative fluid management and "avoidance of salt and fluid overload" - using either pulse pressure variation or oesophageal Doppler, opiate avoiding analgesia - epidural for open procedure and local anaesthesia for laparoscopic surgery, they also included the use of oral alvimopan (a peripheral acting -opioid antagonist); with early mobilisation and early oral nutrition postoperatively. They demonstrated a significant reduction in hospital length of stay (5 vs 8 days, p<0.001), with no change in complications (although ileus rates were decreased) but also importantly showed no change readmission rates. Interestingly given the goal to avoid salt and fluid overload there was no difference in the amount of fluid given (both groups received on average 6 litres of fluid intraoperatively), but despite this the ileus rate still improved. Chris Jones, Guildford. ### Perceptions versus reality, do we do what we think we do? Perceptions versus reality, do we do what we think we do? Baack Kukreja JE, Messing EM, Shah JB. Are we doing "better"? The discrepancy between perception and practice of enhanced recovery after cystectomy principles among urologic oncologists. Urol Oncol. 2016 Mar;34(3):120.e17-21. What is already known? ERAS society has published guidelines for patients undergoing radical cystectomy. (Link) But the uptake of ERAS programs in the US is unclear, so this study attempted to survey US cystectomy surgeons to establish current perioperative care.  What this paper adds? The authors had a 50% overall response rate from the survey, with 64% stating that they were following ERAS principles. However this study found that only 20% of respondents actually practiced all elements. High adherence to the ERAS protocol may be associated with improved 5-year cancer-specific survival after colorectal cancer surgery (Gustafsson 2016). Whilst we do not know that this can be applied to cystectomy surgery, more work needs to be done to improve this low compliance rate. Chris Jones, Guildford. ### ERAS for Lap Gastrectomy  ERAS for Lap Gastrectomy  Abdikarim I, Cao XY, Li SZ, Zhao YQ, Taupyk Y, Wang Q. Enhanced recovery after surgery with laparoscopic radical gastrectomy for stomach carcinomas. World J Gastroenterol. 2015 Dec 21;21(47):13339-44. What is already known: The ERAS society guidelines were published in 2014 (link) but there have been limited studies published in this surgical speciality. What this paper adds: This is a Chinese unblinded randomised controlled trial in patients undergoing laparoscopic assisted gastrectomy surgery. A small reduction in LoS in ERAS group 6.8 (mean) days versus 7.7 days, with no difference in morbidity, mortality or readmissions. There were a number of limitations: No description on how they performed randomisation. Full ERAS protocol not published. ERAS group used epidural analgesia, but no mention on which type of analgesia the standard group used. Chris Jones, Guildford. ### The potential for ERAS in VATS surgery The potential for ERAS in VATS surgery Holbek BL, Horsleben Petersen R, Kehlet H, Hansen HJ. Fast-track video-assisted thoracoscopic surgery: future challenges. Scand Cardiovasc J. 2016;50(2):78-82. What is already known: There is limited evidence for ERAS programmes for minimally invasive thoracic surgery. What this paper adds: This group from Denmark, which includes Henrik Kehlet the founding father of ERAS, perform a review of the literature to date and identify areas requiring further research. They focus on the following aspects: patient selection, anaesthesia, analgesia, chest drain and surgical management. Chris Jones, Guildford. ### Starvation, carbohydrate loading, and outcome after major surgery Starvation, carbohydrate loading, and outcome after major surgery William J Fawcett, Olle Ljungqvist, BJA Education, Volume 17, Issue 9, 1 September 2017, Pages 312–316, What is already known: Preoperative carbohydrate loading has long been an essential part of a successful ERAS programme, where it modifies insulin resistance, improves patient comfort and wellbeing, minimises protein losses, and improves postoperative muscle function. What this paper adds: This excellent review written by two executive committee members of the ERAS Society explores the metabolic changes and stress response following major surgery, the mechanism by which insulin resistance arises. They summarise the evidence behind carbohydrate loading, and in particular explores the more controversial use in patients with diabetes. Chris Jones, Guildford. ### ERAS for elderly patients undergoing pancreaticoduodenectomy ERAS for elderly patients undergoing pancreaticoduodenectomy Partelli S, Crippa S, Castagnani R, Ruffo G, Marmorale C, Franconi AM, De Angelis C, Falconi M. Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB (Oxford). 2016 Feb;18(2):153-8. What is already known: ERAS society guidelines exist for major pancreatic resections (link), and this study aims to study the effects of an ERAS program on elderly patients (>75 years) undergoing pancreaticoduodenectomy, compared to a historical cohort. What this paper adds: A retrospective study demonstrating that ERAS is feasible and safe for elderly patients undergoing pancreaticoduodenectomy. In this small study (88 patients, of which 22 patients underwent an ERAS programme and 66 were historical controls) there was no overall difference in postoperative outcomes, but found a reduced length of stay in patients who had no complications (4 versus 8 days). Adherence to ERAS elements was mixed. Only 9% had their abdominal drains removed early and 32% tolerated starting an oral diet before postoperative day 4. Whilst 95% had epidural analgesia and 90% had early NG tube removal and tolerated early mobilisation. Chris Jones, Guildford. ### Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty. Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty. Talboys R, Mak M, Modi N, Fanous N, Cutts S. Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty. Eur J Orthop Surg Traumatol. 2016 Feb;26(2):177-81. What is already known: This is an interesting paper as it looks at the introduction of an ERAS program for fractured neck of femurs. This is a high risk emergency population with limited ERAS evidence. What this paper adds: This is a retrospective UK study. The authors used a more aggressive analgesic approach including a fascia iliaca block in the ED, a single shot spinal (with no opiate) intraoperatively with TCI propofol sedation. Local anaesthetic was also infiltrated by the surgeon at the end of the procedure. This was all strictly protocolised compared with the pre-ERAS group who either underwent a general anaesthetic with iv opiates or spinal anaesthesia depending on the anaesthetists preference. The authors demonstrated a significant reduction in opiate consumption in the ERAS group however this did not result in a reduced length of stay. Chris Jones, Guildford. ### The nurse’s role in the implementation of an ERAS programme The nurse’s role in the implementation of an ERAS programme Brady KM, Keller DS, Delaney CP. Successful Implementation of an Enhanced Recovery Pathway: The Nurse's Role. AORN J. 2015 Nov;102(5):469-81.  What is already known: The authors are based at the University Hospitals – Case Medical Center in Cleveland, and are experienced in ERAS for colorectal surgery. The senior author has published widely in the area. What this paper adds: This paper describes the nurses role in setting up a successful ERAS program in a number of different surgical specialities. In particular, it stresses the importance of nurses to patient education, assisting patients in meeting ambulatory and dietary targets, providing effective analgesia and ensuring the pathways are successfully followed (including auditing compliance). Chris Jones, Guildford. ### Enhanced recovery after surgery for oncological craniotomies ERAS for Neurosurgery Hagan KB, Bhavsar S, Raza SM, Arnold B, Arunkumar R, Dang A, Gottumukkala V, Popat K, Pratt G, Rahlfs T, Cata JP. Enhanced recovery after surgery for oncological craniotomies. J Clin Neurosci. 2016 Feb;24:10-6. What is already known: The principles of ERAS have been applied to many new specialities over the recent years. One of the newest specialities is Neurosurgery. This group from the US explored how ERAS principles of ERAS could be applied to oncological craniotomies. What this paper adds: The authors should be congratulated for this interesting systematic review of the literature on ERAS for neurosurgery. They reviewed how each element could be applied to neurosurgery, including specific concepts such as scalp blocks and minimally invasive craniotomies. And whilst there is insufficient evidence at present for recommending a specific protocol it does support pursuing future research in this area. Chris Jones, Guildford. ### How does implementing an ERAS program in one speciality affect other specialities? How does implementing an ERAS program in one speciality affect other specialities? Labgaa I, Jarrar G, Joliat GR, Allemann P, Gander S, Blanc C, Hübner M, Demartines N. Implementation of Enhanced Recovery (ERAS) in Colorectal Surgery Has a PositiveImpact on Non-ERAS Liver Surgery Patients. World J Surg. 2016 May;40(5):1082-91. What is already known: The majority of ERAS studies only look at the outcomes of the individual speciality being examined. This looks at the impact on different specialities undergoing different operations but being looked after on the same post-operative ward. What this paper adds: In this retrospective Swiss paper, a colorectal ERAS programme was introduced (but not for liver resection patients), and outcomes of all patients compared before the introduction of an official liver ERAS programme. Overall complication rates did not change but major complications were significantly reduced. Length of stay was reduced by 2 days without increasing readmission rates. It demonstrates that a successful ERAS program in one speciality can have unintended benefits in other unrelated specialities, presumably by a Hawthorne type effect. Chris Jones, Guildford. ### High compliance with ERAS elements can have huge long-term benefits.   High compliance with ERAS elements can have huge long-term benefits.   Gustafsson UO, Oppelstrup H, Thorell A, Nygren J, Ljungqvist O. Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery: A Retrospective Cohort Study. World J Surg. 2016 Jul;40(7):1741-7. What is already known: ERAS protocols have mostly focused on the short-term outcomes such as length of hospital stay, morbidity or hospital costs. This is one of the few papers that have started to look at longer term outcomes. We know from Khuri et al in 2005, that perioperative complications can have a dramatic effect on long term survival (in both cancer and non-cancer surgery). We know that ERAS pathways can reduce morbidity but we don’t know what long-term effect this reduction of morbidity can have. What this paper adds: This is potentially a hugely important paper. In this Swedish single centre study with over 900 patients, they compared adherence of ERAS elements with 5-year overall and cancer specific survival. They found that patients with >70% adherence the risk of 5-year cancer-specific survival was lowered by 42%. And importantly avoiding fluid overload and early oral intake were shown as independent predictors of increased 5-year survival. Chris Jones, Guildford ### Is there a role for enhanced recovery after laparoscopic bariatric surgery? Is there a role for enhanced recovery after laparoscopic bariatric surgery? Barreca M, Renzi C, Tankel J, Shalhoub J, Sengupta N. Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surg Obes Relat Dis. 2016 Jan;12(1):119-26. What is already known: The ERAS society has recently published guidelines for bariatric surgery (link) however there is limited research in this field. What this paper adds: This is a UK review of prospectively collected data from a single specialist centre (288 patients). They showed that an ERAS program was feasible and safe for this group of patients. They demonstrated a significant increase in patients being discharged on postoperative day one after undergoing laparoscopic roux-en-Y bypass (from 1.6% to almost 40%), with no increase in readmission rates. Interestingly neither ASA score or comorbidity had an influence on whether a patient would be discharged on the first post-operative day, (OR:50.95;95%CI:6.55–396.12; P 0.001).  Chris Jones, Guildford.