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Enhanced Recovery After Surgery (ERAS) Protocol

Multimodal perioperative care pathway for shorter hospital stay and fewer complications.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Enhanced Recovery After Surgery (ERAS) Protocol?

ERAS is a structured, multidisciplinary protocol introduced in the late 1990s that bundles 20-25 evidence-based interventions across the preoperative, intraoperative and postoperative phases.

Each intervention targets a specific component of the surgical stress response (catabolism, inflammation, fluid imbalance, ileus, pain) to minimise physiological disturbance.

Originally developed for colorectal surgery, ERAS protocols are now standard in hepatobiliary, pancreatic, urological, gynaecological, thoracic, orthopaedic and bariatric procedures.

Symptoms

Reduction of length of stay by 30-50% across multiple specialities
Reduction of overall complications by 30-40%
Lower rates of postoperative ileus, pulmonary complications and surgical site infection
Earlier return of gastrointestinal function and oral intake
Improved patient satisfaction and quality of life scores
Lower 30-day readmission rates when correctly implemented
Cost reduction estimated at 1500-3000 USD per patient in major surgery

Risk Factors

Older age and ASA physical status III-IV may limit some elements but should not preclude ERAS
Severe malnutrition (BMI under 18.5, weight loss over 10%) requires preoperative optimisation
Active infection or uncontrolled comorbidity should be addressed before elective surgery
Cognitive impairment may complicate adherence and education components
Lack of multidisciplinary team integration is the main institutional barrier
Surgeon and anaesthetist resistance to change reduces protocol adherence and benefit

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • All patients scheduled for major elective surgery should be enrolled in an ERAS programme where available
  • Preoperative nutritional, anaemia and exercise screening should start 4-6 weeks before surgery
  • Smoking and alcohol cessation should be initiated at least 4 weeks preoperatively
  • Persistent postoperative pain, prolonged ileus or unexpected fever needs evaluation despite ERAS
  • Patients should attend the planned outpatient review at 30 days to assess recovery and adherence

Treatment Methods

01
Preoperative: counselling, optimisation of comorbidities, smoking and alcohol cessation, carbohydrate-rich oral drinks 2 hours before surgery (no prolonged fasting)
02
Preoperative: avoidance of routine bowel preparation, prophylactic single-dose antibiotics, mechanical and pharmacologic VTE prophylaxis
03
Intraoperative: minimally invasive surgery when possible, normothermia maintenance, restrictive intravenous fluid therapy guided by goal-directed monitoring
04
Intraoperative: opioid-sparing multimodal analgesia (regional blocks, paracetamol, NSAIDs, dexamethasone)
05
Intraoperative: avoidance of routine drains and nasogastric tubes, early postoperative removal of urinary catheter
06
Postoperative: early oral intake within 4-24 hours, early mobilisation on day of surgery, opioid-sparing analgesia continuation
07
Postoperative: structured discharge criteria, early outpatient review, audit of compliance and outcomes

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.