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ERAS for Patients

Enhanced Recovery After Surgery (ERAS)

ERAS represents an improvement in the way care is delivered to you during your entire surgical journey. As a concept, it is a renewed focus on you, your preparation for and recovery from major surgery.

In practice, it is a set of guidelines that have been developed collaboratively by your anesthesia and surgical teams from the most cutting-edge scientific research. The goal of ERAS is to help you return home faster and have an improved overall surgical experience.

What Is Our Role?

PAA anesthesiologists have been leaders in ERAS at Novant Health facilities since its inception in 2016. We collaborate with key members of your surgical team to create and implement the ERAS pathways, and we’re continually keeping these guidelines updated to reflect the latest research. On a day-to-day basis, our primary role is to ensure that the guidelines are optimized to who you are as an individual. We do this by tailoring our protocols to your medical history, performing specialized nerve blocks, and interpreting data from state-of-the-art monitors. This allows us to optimize variables ranging from the amount of fluid you receive to the settings on the ventilators that breathe for you while you’re asleep, and so much more.

125+ Participating Surgeons

9+ Participating Facilities

GET HOME FASTER

35-60%

Average Reduction in Length of Stay

LESS PAIN, FEWER NARCOTICS

55%

Average Reduction of In-Hospital Opioids

REDUCED COMPLICATIONS

20%

Average Reduction of Discharge and Opioid Prescriptions

Current Adult ERAS Pathways:

Colorectal
Bariatric
Prostatectomy
Gynecologic Oncology
Gynecology

Mastectomy/Reconstruction
Deep Inferior Epigastric Perforator Autologous Breast Reconstruction
Complex Spine
Thoracic
Cardiothoracic

Total Joint Arthroplasty
Cesarean Section
Whipple
Hepatectomy
Gastrectomy

What to Expect From Your ERAS Pathway

Before Surgery:

You’ll be seen in a specified Novant Health Surgical Wellness clinic where you’ll receive instructions and learn about your ERAS pathway.
You’ll be given a complex carbohydrate drink (Clearfast) to maintain adequate hydration. You will be instructed to drink one container the night before your surgery and one container the morning of your surgery.
You’ll be given a special body wash to help prevent infections. You will be instructed to shower with the body wash the night before your surgery and the morning of your surgery. Make sure to put on clean clothes after each shower.
You may be asked to visit your primary care physician or other specialists, such as a cardiologist, to make sure you are optimized for surgery.

Pre-operative

Your pain will continue to be managed in a way that minimizes opioids and maximizes comfort by keeping you on a prescribed schedule of non-opioid pain medications. It’s important to adhere to this schedule in order to stay ahead of postoperative pain. If needed, you may take opioid pain medications, however, many ERAS patients do not need them thanks to this multimodal approach to pain control.
You’ll be given medications for nausea to take as needed. If you had a nausea patch placed before surgery, it can remain on for three days.
Your post-operative diet will depend on your surgery. It’s important that you follow the diet for energy and to promote healing.
You’ll be expected to walk and move around the day of your surgery and beyond. This prevents blood clots.
If at any point you have concerns about the ERAS pathway, you may reach out to us with questions.

Intra-Operative

Evidence-based, best practice recommendations will be used throughout the surgery to ensure individualized management of vital signs, pain control, IV fluid infusions and medication administration.
After monitors and an oxygen mask are placed, you will drift off to sleep with IV medications.
Once you’re asleep, you will have a breathing device placed to support your breathing. This breathing device is removed before you wake up, but it may cause a sore throat for a few days after surgery.
Depending on the procedure, some patients may receive a nerve block (regional anesthesia) after falling asleep. These blocks help reduce pain after surgery.

Post-Operative

After your surgery is complete, we’ll bring you to the recovery area where a nurse will closely monitor your vital signs as you wake up.
Your nurse will ask you about any pain or nausea you feel. He or she will be able to provide medications to treat any discomfort.
Once you’re awake, you’ll be able to have something to drink.
After you’ve recovered from anesthesia, you’ll be transferred to your hospital room (if you are staying the night) or you’ll be discharged (if you had a same-day surgery planned).

Hospital Room or Home

Your pain will continue to be managed in a way that minimizes opioids and maximizes comfort by keeping you on a prescribed schedule of non-opioid pain medications. It’s important to adhere to this schedule in order to stay ahead of postoperative pain. If needed, you may take opioid pain medications, however, many ERAS patients do not need them thanks to this multimodal approach to pain control.
You’ll be given medications for nausea to take as needed. If you had a nausea patch placed before surgery, it can remain on for three days.
Your post-operative diet will depend on your surgery. It’s important that you follow the diet for energy and to promote healing.
You’ll be expected to walk and move around the day of your surgery and beyond. This prevents blood clots.
If at any point you have concerns about the ERAS pathway, you may reach out to us with questions.

What Our Surgical Colleagues and Patients Are Saying

Providence Anesthesia has led the charge in advancing the enhanced recovery pathway. I have had the joy of seeing my patients become the ultimate beneficiaries of these evidence-based practices with reduced post-operative pain, shorter length of stays, and improved satisfaction. As co-chair of the Novant Health Greater Charlotte ERAS committee, I cannot speak highly enough of the commitment to excellence put forth by the Providence Anesthesiology Providers.

Dr. Robert Stevens
Novant Health Charlotte Colon & Rectal Surgery

My experience was excellent, and everyone did a great job explaining ERAS to me. I knew exactly what to expect. I had a lot less pain than I thought. I couldn’t have asked for anything better.

Cardiac Surgery Patient

The development and implementation of the ERAS program at Novant Health has required much work, expertise and collaboration. Providence Anesthesiology Associates has worked seamlessly with the surgeons, nursing staff, and administration to ensure the impressive success of this program resulting in superior patient care and outcomes. As a surgeon, I know my patients are receiving the best care and returning to their normal life as soon as possible.

Dr. Douglas Rosen
Novant Health Charlotte Colon & Rectal Surgery

I have had surgery before and going through the ERAS program for my colon resection surpassed my expectations. I can’t believe how quickly I recovered and with minimal pain.

Colorectal Surgery Patient

It has been a pleasure working with Providence Anesthesiology Associates. Members of their team are always approachable, helpful, and professional. As a Gynecologic Oncologist, a lot of our patients come with significant medical and surgical comorbidity. PAA has provided excellent peri, preoperative, and intraoperative care for our complex patients that always ensures the best outcome. Their incorporation of the ERAS Pathways and locoregional pain control has dramatically improved our patient’s postoperative experience and outcomes. They are an integral part of our team at Novant Health.

Dr. Malcolm Ross
Novant Health Cancer Institute

The ERAS program at Novant Health developed and championed by Providence Anesthesiology has dramatically improved our bariatric surgery program. We have seen decreased post-operative pain, decreased opioid usage, decreased PONV, decreased hospital LOS, and improved patient satisfaction. We also appreciate the fact the ERAS Program at Novant is evidence-based, data-driven, and continually improved. Our partnership with Providence Anesthesiology to create, develop and maintain this program has been outstanding.

Dr. David Voellinger
Novant Health Bariatric Solutions Charlotte

Our plastic and reconstructive surgery patients have had incredible outcomes with ERAS. This well-published method has been exemplified in our ERAS DIEP flap breast reconstruction patients who have a rapid recovery and smooth postoperative stay largely due to ERAS. Their experience has been so great we recently had one of our patients share their experience with Charlotte News Channel 9 on how well it went and they are back to exercising and feeling great after a big surgery made more safe and efficient with ERAS.

Dr. Blair A. Wormer
Novant Health Appel Plastic Surgery

Both as a provider and a patient, I cannot speak more highly of the ERAS protocol in recovering from a c-section. I have seen patients recover faster in the hospital, which greatly has facilitated bonding time with their newborn without pain in the way. As a patient, I have noticed a positive change from my previous c/s without ERAS and then with. I hope this process can be implemented across the board for our patients.

Dr. Stephanie Barbadora-Froelich
OB/GYN Novant Health Noda OBGYN

Frequently Asked Questions

What is ERAS?

ERAS stands for Enhanced Recovery After Surgery. ERAS uses evidence-based guidelines to improve a patient’s overall surgical experience, reduce pain and improve outcomes.

What are the key points of ERAS?

ERAS revolves around 4 main principles:

Making the patient a partner in their own care.
Optimizing the patient to their best possible health preoperatively.
Using evidence-based management that minimizes surgical harm and improves outcomes.
Providing care that enables the patient to return to their normal level of activity as soon as possible.

How did ERAS start?

In the 1990s, a surgeon from Denmark named Henrik Kehlet was not satisfied with the status quo for the perioperative management of his surgical patients. He began to try to improve outcomes for his patients by giving his patients clear liquids before surgery and encouraging them to eat and walk right after surgery. He also decided to treat them with non-opioid medications for pain. He noted his patients were recovering faster than before so he called this new discovery “Fast Track Surgery.” In 2002, the English Parliament and an anesthesiologist named Monty Mythen figured out that hospitals using Henrik Kehlet’s Fast Track model were doing better than those who were not. They decided they would adopt this system with a new name: Enhanced Recovery After Surgery. ERAS has now expanded to other parts of the world, including the United States.

How long has ERAS been at Novant?

ERAS started at Novant in 2016. PAA has been involved with the development of the program and its pathways since the beginning. We collaborate with surgeons and Novant to create the best possible outcomes for our patients.

What should I expect before my surgery as an ERAS patient?

Your journey as a patient will begin in the office when your surgeon determines you would benefit from having an ERAS surgery. At that time, he or she will give you a brief overview of your ERAS pathway along with some reading material. Before surgery, you will have an appointment at a Novant Health Surgical Wellness Clinic for your preanesthesia visit. During this visit we will go over your medical history to make sure you are optimized for surgery. If needed, some patients may need to be referred to specialists such as a cardiologist or pulmonologist. During this visit you’ll also receive your Clearfast (carbohydrate drink) as well as a “Patient’s Guide To ERAS” booklet. This is a great time to bring up any questions you may have. Research shows that patients who know what to expect before, during and after surgery do much better than patients who are not as involved. Our goal is for you to be a partner throughout this whole process and for you to have all of your questions answered before you head into the operating room.

What is Clearfast?

Clearfast is a complex carbohydrate drink. Drinking Clearfast helps to reduce hunger, thirst and nausea before surgery by keeping you hydrated. It also helps to decrease post-op insulin resistance, infection and nausea. You will receive two bottles of Clearfast at your visit with the Wellness Clinic. The first Clearfast drink will be consumed the night before your surgery and the second will be consumed three hours before your scheduled surgery time. The Clearfast consumed on the day of your surgery should be completed in 5 minutes to receive its full effects. Clearfast is better if refrigerated.

What is multimodal pain management?

Multimodal pain management refers to taking non-opioid pain medication to help control pain and reduce the need for opioid medication. Multimodal medications are given to you before, during and after surgery as part of our ERAS protocols. These include medicines like Tylenol, NASIDs, numbing and nerve medications. Research proves that using a multimodal approach leads to patients using less opioid medication during and after surgery. This, in turn, leads to a decrease in side effects such as sedation and constipation. Reducing opioid use also helps us to combat the opioid epidemic that continues to affect the United States.

What if my pain is not be controlled?

Research and data have shown that when using multimodal pain medications throughout the patient’s journey, pain is reduced and less medication is needed. However, if you are having breakthrough pain, don’t worry; there will be traditional pain medication available if needed. Your team will assess your pain often to ensure it’s well managed.

Why is it important to walk and move after surgery?

Walking and being active have been shown to decrease pain, surgical complications, and the amount of time you spend in the hospital after surgery. You will first begin walking the day of surgery as soon as it is safe. The day after surgery, the goal is for you to walk at least three times a day and be out of bed in a chair when you’re not sleeping. After that, the goal is for your walking to increase to four to six times a day and for you to be in a chair when you’re not sleeping.

ERAS patients are discharged home quickly, how will you know I'm ready to go home?

The goal of ERAS is to use all four principles together, which results in patients being in the hospital fewer days than in the past. Some patients may not require a hospital stay at all. You are assessed daily by your surgeon to ensure you are ready when you leave the hospital. With ERAS, patients can meet discharge goals sooner than without ERAS.

Will I be able to eat soon after surgery?

Yes, you will be able to eat very soon after surgery. Your surgeon will determine what type of diet is best for the postoperative period. As soon as you are awake without nausea or vomiting, you will be able to eat the diet prescribed to you.

What happens after I leave the hospital?

When you leave the hospital, you will continue the multimodal pain medication at home. You may or may not be given a prescription for opioid pain medication (for breakthrough pain) depending on your comfort level before discharge. You will continue walking several times a day and eating a healthy diet. It is important to keep all postoperative appointments with your surgeon. If any concerns arise, you can always reach out to your surgeon’s office with any questions.

What if I still have more questions?

If you still have questions, please don’t hesitate to fill out the form below or you can reach our ERAS coordinator Vicki Morton at vicki.morton@provanesthesiology.com.

You may also be able to find answers to your questions in the patient information center of the:

ERAS ® Society
‍ERAS ® Cardiac Society
Evidence-Based Perioperative Medicine (EBPOM)
‍American Society of Enhanced Recovery (ASER)
‍Perioperative Quality Initiative (POQI)

If you have a non-urgent question about ERAS please click the button
and fill out the form and our ERAS coordinator will be happy to assist you.

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