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Skip to 0 minutes and 16 seconds What is ERAS? Enhanced recovery is based on the question why are you in hospital? What are the problems the patient’s having? And when you dissect down the problems, you change, you improve, and that is enhanced recovery. The key problem is why is it dangerous, potentially dangerous, to have an operation? And why do we have to have so much undesirable pain? Why does it take weeks to recover after a major operation? That’s what it’s all about.

Skip to 0 minutes and 56 seconds What are the key components of an ERAS pathway? It depends on the surgical procedure, because every procedure has its own recovery problems. So there’s no fixed answer to that, but in general of course, pain management is a prerequisite for an enhanced recovery programme; fluid management, blood management, physiotherapy type of surgical technique, and the stress responses to surgery, that will increase the pressure on the different organs. And then you have to modify these stress responses. So it’s a multimodal effort.

Skip to 1 minute and 44 seconds How did ERAS develop and what were the main drivers for change? I can only talk for myself. I think it was 30 years ago, we published a very effective pain management in four types of surgery. Nothing happened. Nothing happened. The patient stayed in hospital, happy in bed. Nothing happened. So that suddenly changed my mind that you had to have an integrated approach to recovery. First to provide effective analgesia, and then to utilise it. And then all the other factors came in. You had to modify everything in one time.

Skip to 2 minutes and 30 seconds What were the barriers to change? Not for me, because I was lucky to have so many friends in anaesthesia because I’m a surgeon. But obviously around the world there are so many barriers; lack of knowledge, lack of your own data compared to the leader through a lack of leadership, lack of understanding of the concept, etc. There are many barriers.

Skip to 2 minutes and 57 seconds Why do you think ERAS has been so successful? That’s quite obvious, because the patients are better. You have fewer medical complications. You shorten the need for hospitalisation. I think every patient wants to be home, provided that they are well. But they are getting well faster with these programmes. And then we have a very special situation that you improve quality, at the same time you save money. I can’t find many examples in health care.

Skip to 3 minutes and 36 seconds How do you think ERAS pathways will develop in the future? Of course, to implement what we know we should do. But for me, it’s further understanding of these undesirable inflammatory and immunological responses to surgery that will influence recovery. That’s the key research question. The next one is to have better procedure specific analgesia because, as I said before, optimal pain management is a prerequisite for recovery. So these are the two key things– and blood management. In the beginning, blood management was not really integrated in enhanced recovery. I don’t– I can’t explain it now, but blood management now is also a very important factor.

What is Enhanced Recovery After Surgery (ERAS)?

Professor Henrik Kelhet is the professor of perioperative therapy at Rigshospitalet, Copenhagen University. He is one of the most important figures in the development of the enhanced recovery pathway.

In this video, Professor Kehlet explores the concept of enhanced recovery and why changes needed to be made in the patient pathway to improve outcomes (Please accept our apologies for the background noise in this video - as Professor Kehlet is a busy eminent figure, we were fortunate enough to interview him during an international conference).

In the next few steps we will expand on these ideas further by considering the specific elements of enhanced recovery pathways from the viewpoint of patients and healthcare professionals.

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This video is from the free online course:

Perioperative Medicine in Action

UCL (University College London)