AANA Updates Policy Considerations for Enhanced Recovery After Surgery

ERAS Pathway Improves Positive Patient Outcomes

ROSEMONT, Ill. — The American Association of Nurse Anesthesiology (AANA) recently updated and approved its policy considerations for Enhanced Recovery after Surgery (ERAS), for pathway development and implementation. These policy considerations were revised through the AANA evidence-based process, involving a systematic keyword search, a review of relevant research, and revision of document content to reflect most current evidence.

Enhanced Recovery after Surgery (ERAS) refers to the patient-centered, evidence-based, interdisciplinary team-developed series of medical decisions for a surgical specialty to reduce the patient’s surgical stress, optimize their health prior to and during surgery, and facilitate faster recovery.

“Growing evidence suggests that ERAS pathway contributes to improved patient outcomes, reduces postoperative problems and accelerates recovery,” said AANA Director of Region 3 Daniel King, DNP, CRNA, CPPS, CNE and lead author of the revised policy considerations. “As a result, there is also a decrease in hospital and patient cost when complications are reduced and hospital stays are minimized.”

Each element of the ERAS pathway is important to successful patient recovery and chief among its benefits is it can be modified to address each patient’s unique needs. Each patient must be evaluated for the eligibility and the appropriateness of the ERAS in their plan of care. This patient optimization stage is crucial to the success of ERAS since it is when patients learn what they can do to get in better physical condition prior to the procedure as well as how comorbidities, such as high blood pressure, chronic airway disease and diabetes, can be addressed prior to surgery.

Key elements of successfully integrating ERAS into the plan of care include patient/family education, patient health optimization prior to admission, fasting and meal instruction, and use of multimodal analgesia, thus allowing the patient to more quickly return to normal diet and activities after surgery and return home.

The ERAS pathway begins when patients visit their surgeon and the office team with a focus on patient education, establishing patient expectations, engagement, and the development of a plan to optimize their health before surgery. The goal of the preoperative phase includes assessing the patient’s state of health and identifying risk factors that may prolong recovery or lead to complications.

During the preoperative phase, patients are encouraged to contribute and participate in their plan of care. This includes providing the patient detailed instructions prior to the procedure or surgery and providing necessary resources such as recommended meals and a pain management technique that involves combining multiple types of medications to treat pain. This is also the time to discuss discharge planning, education, and a home medication plan with patients and family/caregiver.

During the intraoperative phase, the CRNA uses a combination of anesthesia medications, which can include regional anesthesia and pharmacological medications based on the patient’s pain management plans. Using multiple types of anesthesia medications may eliminate or significantly reduce the use of opioids and adverse side effects such as respiratory depression during surgery, postoperative nausea and vomiting and delayed return of gastrointestinal function.

As patients are in the postoperative phase, they are assessed and evaluated by a CRNA or another anesthesia provider, noting their recovery status and return to normal diet and daily activities. When the criteria is met for discharge, including ability to eat and drink without nausea or vomiting, acceptable respiratory status and without further complications, patients receive instruction and strategies to aid recovery. The patients’ ERAS pathway and the participation of their interdisciplinary team continue when they return home.

“Throughout the implementation of all phases of ERAS pathways, CRNAs are uniquely qualified to achieve positive patient outcomes successfully,” said King. “As evidence-based anesthesia experts, CRNAs are well-positioned as champion leaders of patient-centered teams to achieve ERAS excellence.”