Revisiting enhanced recovery pathways

Enhanced recovery is a quality improvement programme with a complex number of different elements which are evidence based and have an impact on the patient’s recovery after elective surgery. NHS Improvement describes it as designed to improve the patient experience, improve clinical outcomes and reduce the demand on inpatient beds.1 It is very much a planned process, involving the whole surgical team and the patient and their family. The main aim is to speed up recovery after surgery and to ensure that patients get the best possible experience. 

Enhanced recovery programmes are widespread around the country – although they are far from ubiquitous. The most common areas of care, where research has demonstrated the most improvement, are breast care, colorectal, gynaecological, musculoskeletal and urological surgery. There are a few hospitals where thoracic and cardiac surgery utilise enhanced recovery principles. You might ask why this is not practiced as a matter of routine for every speciality and in every hospital.

Greenshields and Mythen,2 writing in January 2020, reviewed the progress of the last ten years in adoption of the enhanced recovery (ERAS) principles and state that while there has been significant progress across multiple surgical specialities, there is difficulty in sustaining a target of more than 80% compliance. However, optimistically they state that, in terms of the current interest in perioperative medicine and prehabilitation, more focus is landing on enhanced recovery.