Operational
Enhanced Recovery After Surgery
Also known as: ERAS, enhanced recovery, fast-track surgery
Enhanced Recovery After Surgery is a structured approach that bundles evidence-based steps across the whole surgical pathway to reduce the physiological stress of surgery and speed recovery. A substantial part of it is pre-operative — optimising comorbidity, correcting anaemia, avoiding prolonged fasting and preparing the patient — which makes early assessment a precondition rather than an adjunct.
- Scope
- The whole pathway — before, during and after surgery
- Pre-operative components
- Comorbidity optimisation, anaemia correction, avoiding prolonged fasting, patient preparation
- Aim
- Reduce the physiological stress of surgery and speed return to function
- Dependency
- The pre-operative elements need lead time, so they depend on early assessment
The part that happens before admission
ERAS is often discussed in terms of what changes intraoperatively and on the ward. But a meaningful share of the protocol is pre-operative, and those elements share a property: they need lead time.
Optimising diabetes control, correcting iron-deficiency anaemia, addressing smoking, setting expectations about mobilisation and discharge, and replacing “nil by mouth from midnight” with clear fluids up to the permitted window — none of these can be delivered in the days before surgery.
Why it exposes the assessment bottleneck
This is the practical difficulty services encounter when adopting ERAS. The protocol assumes patients are identified and prepared well ahead of their procedure. A pre-admission clinic booked out three weeks in advance, allocating slots in the order bookings arrive, cannot reliably deliver that — not because the clinic is doing poor work, but because the patients who most need the pre-operative components are not necessarily the ones who reach it in time.
Assessing every booked patient at the point of booking is what makes the pre-operative half of an ERAS pathway operable at scale.