Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
Royal Surrey County National Health Service Foundation Trust, University of Surrey, Guildford, England3Department of Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond.
JAMA Surg. 2017 Mar 1;152(3):292-298. doi: 10.1001/jamasurg.2016.4952.
Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings.
Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties.
Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.
手术后快速康复（ERAS）是围手术期护理的范式转变，可显著改善临床结果并节省成本。
手术后快速康复是一种多模式、多学科的外科患者护理方法。手术后快速康复方案的实施涉及一个由外科医生、麻醉师、手术后快速康复协调员（通常是护士或医师助理）以及照顾外科患者的科室人员组成的团队。护理方案基于已发表的证据。促进、开发和实施手术后快速康复方案的国际非营利专业协会——手术后快速康复协会，为许多手术发布了更新的指南，例如基于证据的现代护理改变，从术前禁食一夜改为手术前 2 小时饮用碳水化合物饮料，采用微创方法代替大切口，管理液体以寻求平衡而不是大量静脉输液，避免或早期移除引流管和引流管，早期活动以及在手术当天提供饮料和食物。手术后快速康复方案导致住院时间缩短 30%至 50%，并发症相似减少，同时降低了再入院率和成本。方案的各个要素减轻了手术的应激以保留合成代谢平衡。手术后快速康复协会开展了结构化的实施计划，目前在 20 多个国家使用。医院的当地手术后快速康复团队接受培训以实施手术后快速康复流程。审核流程合规性和患者结果是重要特征。手术后快速康复最初主要应用于结直肠手术，但已证明可改善几乎所有主要外科专业的手术结果。
手术后快速康复是一种基于证据的外科患者护理改进方法。实施手术后快速康复方案可显著改善临床结果和成本，使手术后快速康复成为应用于手术的基于价值的护理的重要范例。
