Surgery can be stressful, but recovery does not have to mean spending many days in bed, waiting for your body to slowly return to normal. Enhanced Recovery After Surgery (ERAS) is a structured approach that helps patients prepare for surgery, recover safely, and return to their normal activities sooner.
Instead of focusing only on what happens inside the operating room, an ERAS protocol considers the entire surgical journey, from preoperative preparation to recovery at home. It brings surgeons, anaesthetists, nurses, dietitians, physiotherapists and patients together as part of the recovery process.
What is Enhanced Recovery After Surgery?
ERAS stands for Enhanced Recovery After Surgery. It is not a single treatment or medicine. It is a set of evidence-based steps designed to reduce the physical stress of surgery and support recovery.
The exact protocol can vary depending on the type of surgery, your health and your hospital. However, it commonly includes:
- Preparing your body before surgery
- Avoiding unnecessary prolonged fasting
- Using effective pain relief with fewer side effects where appropriate
- Preventing nausea and other common complications
- Starting food and fluids at the appropriate time
- Getting out of bed and moving early
- Planning your discharge and recovery at home
The goal is not simply to send patients home quickly. The goal is safe recovery and a quicker return to normal life.
Why does the ERAS protocol matter?
Traditional surgical care may sometimes involve prolonged fasting, extended bed rest and waiting for bowel function to return before eating or moving around.
ERAS has changed this approach by encouraging recovery activities as soon as they are safe.
A large meta-analysis of randomised clinical trials found that ERAS care was associated with a shorter hospital stay and fewer postoperative complications compared with usual care. The review included 74 trials and more than 9,000 participants.
This does not mean every patient will recover at the same speed. Age, the type of operation, existing health conditions and complications can all affect recovery.
What does an ERAS protocol involve?
ERAS usually covers three important stages: before surgery, during surgery and after surgery.
1. Before surgery: Prepare your body: Recovery begins before you enter the operating room.
Your healthcare team may assess your nutrition, physical fitness, existing medical conditions and medications. If you smoke, you may be advised to stop. Your doctor may also recommend improving your nutrition or physical activity before surgery when appropriate.
Good preparation can be particularly important before major surgery because poor nutrition and significant weight loss may affect recovery.
You may also receive clear instructions about:
- When to stop eating and drinking
- Which medicines to take or temporarily stop
- What to expect after surgery
- Pain management
- Getting out of bed and walking after surgery
- Planning for discharge
Knowing what to expect can also make the recovery process less stressful.
2. During surgery: Reduce stress on the body: The ERAS approach also guides care during the operation.
Depending on the procedure, this may include careful management of fluids, maintaining body temperature, preventing infections, controlling blood sugar when needed and using appropriate pain relief.
Pain management may involve more than one method so that reliance on opioid medicines can sometimes be reduced. The exact combination depends on the surgery and the patient's health.
Current ERAS recommendations include several common principles such as appropriate pain and nausea management, infection prevention, fluid management and nutritional care.
3. After surgery: Start recovery early: Once it is safe, patients are encouraged to become active rather than remaining in bed for longer than necessary.
This may involve:
- Sitting up and getting out of bed
- Walking with assistance
- Starting fluids and food when appropriate
- Managing pain effectively
- Removing tubes and catheters when they are no longer needed
- Continuing breathing or physical exercises when advised
Early movement can help support physical recovery and reduce some problems associated with prolonged immobility.
For example, after certain abdominal operations, ERAS pathways may support earlier return to eating, bowel function and mobility. Research has found improvements in several of these recovery measures compared with conventional care.
What are the benefits of ERAS surgery?
The benefits depend on the type of surgery and how well the pathway can be followed. Research suggests that ERAS programmes can:
- Reduce the length of hospital stay
- Reduce some postoperative complications
- Support earlier movement and normal activity
- Improve recovery of bowel function after certain operations
- Help patients take a more active role in their recovery
A systematic review of ERAS programmes found consistent evidence of reduced hospital stay and healthcare costs across several types of surgery.
However, ERAS does not guarantee a faster recovery for every patient. If complications occur or a patient needs additional treatment, the recovery plan may need to change.
Is ERAS suitable for everyone?
ERAS can be used for many planned surgical procedures, but there is no single protocol that fits everyone.
Your ERAS plan may depend on:
- Type and complexity of surgery
- Age and overall health
- Nutritional status
- Other medical conditions
- Whether the surgery is planned or an emergency
- How your body responds after surgery
Even emergency surgery may use selected ERAS principles when appropriate, although the pathway needs to be adapted to the patient's condition. Research has found potential benefits in emergency abdominal surgery as well.
What can you do to support your recovery?
You are an important part of the recovery process.
Before surgery:
- Follow your doctor's instructions about food, fluids and medicines.
- Tell your healthcare team about all medicines and supplements you take.
- Ask whether you need to improve your nutrition or physical fitness before surgery.
- Stop smoking if advised.
- Understand what will happen after the operation.
After surgery:
- Follow instructions about walking and physical activity.
- Eat and drink according to your care team's advice.
- Take pain medicines as prescribed.
- Perform breathing or physiotherapy exercises if recommended.
- Tell your healthcare team about increasing pain, fever, breathing difficulty, vomiting or other concerning symptoms.
Do not try to walk, eat or change your medicines earlier than advised. ERAS is about early recovery when it is safe, not rushing the process.
How is ERAS different from traditional surgical care?
The biggest difference is the overall approach.
ERAS does not mean replacing good surgical care. It brings different aspects of care together in a planned and coordinated way.
Conclusion
Enhanced Recovery After Surgery is a patient-centred approach that starts before surgery and continues through recovery at home. By combining good preparation, careful surgical care, effective pain management, appropriate nutrition and early movement, ERAS can help many patients recover more efficiently.
The most important point is simple: recovery does not start after surgery. It starts with preparation before surgery and continues with active, safe participation throughout the recovery journey.
How PB Health can support you
PB Health can support you throughout your surgical journey by helping you understand your treatment and recovery plan, address concerns after surgery, and connect you with the right healthcare professional when needed. Our goal is to make your recovery clearer, more informed and less stressful.
Learn more about coordinated surgical care and recovery support at PB Health Hospital, IFFCO Chowk, Gurgaon.