Enhanced Recovery After Surgery (ERAS) at UPMC in Central Pa.

Enhanced Recovery After Surgery (ERAS) is a patient-centered program designed to promote optimal surgical recovery and reduce the risk of post-surgical complications.

What is ERAS?

ERAS is a specialized, multidisciplinary program designed to promote optimal recovery after surgery. The goal of ERAS is to improve the quality of surgical care by taking steps before, during, and after surgery to decrease the length of stay in the hospital, reduce recovery time, and prevent complications, re-admissions, and same-day surgery cancellations. ERAS includes:

• Pre-surgical education, screenings, treatments, and information to ensure that patients are as prepared and as healthy as possible before having surgery.
• Intraoperative measures taken during surgery to reduce post-surgical discomfort and promote optimal recovery.
• Postoperative care designed to manage discomfort, minimize the use of opioid pain medications, promote mobility, and restore normal bowel function.

Optimizing Recovery Before Surgery (Preoperative Care)

At UPMC in Central Pa., we understand that the first step toward a successful recovery from surgery is providing each patient with the education, information, screenings, and treatment they need to ensure that they are as informed, prepared, strong, and healthy as possible before heading into the operating room.

Our ERAS program provides a full range of preoperative services designed to promote optimal recovery. Our ERAS services, which are customized to each patient’s unique needs, include:

• Counseling and education. Our pre-surgical staff will meet with each patient in the office to explain what they should expect before, during, and after their procedure. Topics discussed may include discharge planning, pain management, managing other health conditions, and pre- and post-operative nutrition and exercise. Each patient will meet with all members of the surgical team and receive written and oral information and instructions about their procedure.
• Pre-surgical instructions. Each patient will receive preoperative instructions, which may include fasting guidelines and instructions on preoperative carbohydrate loading, if applicable.
• Testing and screening. Each patient will receive preadmission testing and screening, which may include:
• Diabetes screening
• Post-operative nausea and vomiting screening
• Sleep apnea screening
• Screening for nicotine and alcohol use
• Nutritional risk screening
• Nutrition education. Research has shown that nutrition plays a crucial role in recovery and suggests that inadequate nutrition may increase the risk of surgical complications. Pre-surgical patients at UPMC Pinnacle may receive nutrition education to promote healthy weight management/weight loss, increased protein intake, and proper nutrition before surgery.
• Exercise counseling. To increase strength and improve recovery, patients are encouraged to walk 30 minutes per day in advance of their surgery. Each patient will also receive information on other strength-training and mobility exercises that they can perform in advance of surgery.
• Nicotine and alcohol cessation. Patients are encouraged to abstain from nicotine and alcohol use for at least 8 weeks before surgery. If necessary, patients may be referred to a smoking cessation counselor or other supportive services.

Optimizing Recovery During Surgery (Intraoperative Care)

Our surgical teams take steps during surgery to promote the best possible surgical results and optimal recovery. Intraoperative measures may include:

• Reducing intraoperative use of opioids for pain control
• Pain management using multiple medications to reduce opioid use or techniques such as regional anesthesia
• Nausea and vomiting prevention
• Performing minimally invasive surgery whenever possible

Optimizing Recovery After Surgery (Postoperative Care)

At UPMC Pinnacle, our post-surgical care teams follow specialized, evidence-based protocols designed to help patients recover safely and quickly. In addition to reducing the risk of post-surgical complications, our protocols are designed to reduce the length of stay in the hospital — allowing our patients to safely return home or transfer to another facility more quickly. Postoperative measures may include:

• Encouraging patients to get out of bed and walk soon after surgery. Early mobility is associated with faster recovery and better surgical outcomes.
• Promoting normal bowel function. Surgery, pain medication, and anesthesia can cause temporary constipation and other digestive problems, which sometimes lead to post-surgical complications. Patients will be encouraged to eat and get out of bed as soon as possible after surgery, which may help to reduce discomfort and restore normal bowel function. If necessary, patients may also be encouraged to chew gum, drink coffee or take gentle medications to stimulate their bowels.
• Pain management using multiple medications or techniques, such as prescription and non-prescription pain medications, topical medications, and other therapies (such as regional anesthesia).
• Minimizing the use of opioid pain medication. To reduce the risk of complications related to the use of opioid pain medications, patients will be transitioned to non-prescription pain medications as soon as possible.
• Removal of tubes and drains. Tubes and drains will be removed as soon as possible to promote improved mobility, reduced discomfort, and faster healing.
• Following all post-operative discharge instructions.
• Wash hands with soap and water frequently to prevent infection
• Inspect incision daily for signs and symptoms of infection including redness, swelling or drainage. Call surgeon immediately if you have any signs or symptoms of infection and or a fever greater than 100.4 Call your surgeon for uncontrolled pain
• Make sure to keep all post-operative follow up appointments as directed.

Patient Education

• Pre-Surgery Nutritional Education-High Protein (PDF)
• Pre-Surgery Nutritional Education-Obesity (PDF)
• Patient Education: Ensure Pre-Surgery (PDF)
• Seated Exercises for Older Adults
• Opioids General Information
• Walking for Exercise
• Enhanced Recovery after Surgery (ERAS) Chlorhexidine Soap (PDF)
• How to Get Moving while in the Hospital
• Preventing Problems after Surgery
• Smoking and Wound Healing
• Skin Care after Surgery
• Surgery with Diabetes
• Surgery with Sleep Apnea
• Surgery with Obesity
• Dental Concerns before Surgery
• ERAS patient education booklet