Enhanced recovery after surgery (ERAS) in the oncologic patient

Enhanced Recovery After Surgery (ERAS) is a term used to describe perioperative care protocols that have been demonstrated to improve patient outcomes after major oncologic surgery. In 2001, a group of academic surgeons invented ERAS with the goal of developing optimal perioperative pathways that will provide optimal care throughout the patient's journey. Some authors use other terms such as enhanced recovery programs (ERP) or fast-track surgery. ERAS guidelines include a series of perioperative evidence-based interventions to maintain physiological function, enhance mobilization, minimize pain, and facilitate early oral nutrition postoperatively by reducing perioperative surgical stress. Further, the guidelines strive to attenuate the loss of functional capacity after surgery (Lassen et al. World J Surg. 2013;37:240-58). The adoption of ERAS will improve outcome as evidenced by morbidity rate reduction, faster recovery, and decrease length of hospital stay (Thorell et al. World J Surg. 2016;40:2065-83). The effectiveness of ERAS protocols has shown to be beneficial in the maintenance of homeostasis via controlling metabolism and fluid shifts, and the support of the return of key functions through early detection and rescue of symptom burden. The principles of ERAS are gaining ground and spreading into a range of different surgical specialties and procedures. The utilization of evidence-based ERAS protocols will minimize healthcare team's practice variation resulting in patient engagement, timely quality recovery, safety, positive outcomes, and cost reduction. The chapter will describe the implications of ERAS pathways when caring for oncologic patients perioperatively through interdisciplinary approach. A key focus for critical care teams is to provide a comprehensive overview and targeted areas of care to implement interventions consistent with new healthcare delivery trends.