# Enhanced Recovery After Surgery

> Enhanced Recovery After Surgery is a structured approach that bundles evidence-based steps across the whole surgical pathway to reduce the physiological stress of surgery and speed recovery. A substantial part of it is pre-operative — optimising comorbidity, correcting anaemia, avoiding prolonged fasting and preparing the patient — which makes early assessment a precondition rather than an adjunct.

*Source: https://getpathways.ai/glossary/enhanced-recovery-after-surgery*

Also known as: ERAS, enhanced recovery, fast-track surgery

- **Scope**: The whole pathway — before, during and after surgery
- **Pre-operative components**: Comorbidity optimisation, anaemia correction, avoiding prolonged fasting, patient preparation
- **Aim**: Reduce the physiological stress of surgery and speed return to function
- **Dependency**: The pre-operative elements need lead time, so they depend on early assessment

## The part that happens before admission

ERAS is often discussed in terms of what changes intraoperatively and on the
ward. But a meaningful share of the protocol is pre-operative, and those
elements share a property: they need lead time.

Optimising diabetes control, correcting iron-deficiency anaemia, addressing
smoking, setting expectations about mobilisation and discharge, and replacing
"nil by mouth from midnight" with clear fluids up to the permitted window — none
of these can be delivered in the days before surgery.

## Why it exposes the assessment bottleneck

This is the practical difficulty services encounter when adopting ERAS. The
protocol assumes patients are identified and prepared well ahead of their
procedure. A pre-admission clinic booked out three weeks in advance, allocating
slots in the order bookings arrive, cannot reliably deliver that — not because
the clinic is doing poor work, but because the patients who most need the
pre-operative components are not necessarily the ones who reach it in time.

Assessing every booked patient at the point of booking is what makes the
pre-operative half of an ERAS pathway operable at scale.