Revolutionizing Perioperative Care: AORN's New Enhanced Recovery After Surgery (ERAS) Guideline

The Association of periOperative Registered Nurses (AORN) guideline on The Implementation of Enhanced Recovery After Surgery (ERAS) marks a significant step forward in perioperative patient care. This comprehensive, evidence-based guideline aims to standardize and optimize care across all surgical settings, ultimately leading to improved patient outcomes and experiences. 

What does ERAS mean?

ERAS stands for enhanced recovery after surgery. Enhanced Recovery After Surgery (ERAS) is a patient-centered, evidence-based approach to achieve the best surgical outcomes by enhancing the recovery process.

What is ERAS? And why is it important?

According to Dr. Lisa Spruce, Sr. Director of Evidence-Based Perioperative Practice at AORN, ERAS isn't a new concept. It originated in Europe and has been gaining traction globally. However, AORN's new guideline provides a crucial framework for implementation in the United States, addressing the unique needs and challenges faced by perioperative teams here. Dr. Spruce emphasized that AORN believes ERAS should be the standard of care for all surgical patients, regardless of the procedure.

Who was involved in developing the ERAS guideline?

AORN brought together a diverse group of stakeholders, including perioperative nurses, surgeons, anesthesia providers, pharmacists, infection preventionists, and members of their guideline advisory board, said Dr. Spruce. This collaborative effort ensured that the guideline reflects the multifaceted nature of perioperative care and addresses the needs of the entire surgical team.

What is the ERAS protocol?

ERAS is a comprehensive approach involving a multidisciplinary team that implements best practices throughout the perioperative journey, from pre-admission through post-discharge. AORN emphasizes that ERAS aims to standardize care, reduce variability, and ultimately improve patient outcomes. While AORN's focus is on perioperative nursing, the organization recognizes ERAS as a collaborative, interprofessional effort. The AORN guidelines provide a framework for implementing ERAS principles in various surgical settings.

What are the AORN ERAS pre-op recommendations?

The guideline covers all phases of surgical care, from pre-op preparation to post-op recovery. In the pre-op phase, the focus is on patient-centered interventions, including comprehensive education, optimizing patient health, implementing surgical site infection prevention bundles, and initiating multimodal pain management. Dr. Spruce highlighted the importance of pre-op education and the need to prepare patients for surgery, including proper fasting guidelines and risk assessments. She explained that multimodal analgesia, a key component of ERAS, targets various physiological pathways to prevent pain and minimize the adverse effects of narcotic pain medication.

What are the AORN ERAS intra-op recommendations?

During the intra-op phase, the guideline emphasizes standardized anesthesia protocols, tailored fluid management, and the continuation of multimodal analgesia. AORN also strongly recommends the use of minimally invasive surgical techniques whenever possible. The benefits of these techniques are numerous, including reduced complications, decreased blood loss, improved pain management, shorter hospital stays, and faster recovery.

What are the AORN ERAS post-op recommendations?

Post-op, ERAS focuses on minimizing pain, encouraging early mobilization, promoting early return to a normal diet, and removing indwelling catheters and drains as soon as clinically appropriate. The guideline also addresses post-discharge care, including physical therapy and other interventions to support continued recovery.

What are the challenges in implementing the AORN ERAS guideline and how can they be overcome?

Implementing ERAS requires careful planning, multidisciplinary collaboration, and a structured approach. The guideline provides a step-by-step implementation table to guide teams through the process. Dr. Spruce acknowledged that one of the biggest challenges is getting teams to collaborate effectively and implement standardized protocols. She stressed the importance of a team committed to continuous improvement and overcoming variations in care driven by individual provider preferences.

What are the benefits of ERAS beyond patient outcomes?

The benefits of ERAS extend beyond individual patient outcomes. Standardized care promotes equity in care, helping to decrease healthcare disparities. Furthermore, ERAS has been shown to reduce costs, decrease opioid usage, improve overall outcomes, and get patients home sooner and healthier.

What is the future of ERAS and AORN's role in its advancement?

Looking ahead, Dr. Spruce anticipates further research and the development of more specialized ERAS protocols, particularly for pediatric, older adult, and other special populations. She also emphasized the importance of learning from international experiences with ERAS implementation.

How to access the AORN ERAS guideline?

AORN's new ERAS guideline is a valuable resource for all members of the perioperative team and represents a significant step towards a future where ERAS is the standard of care for every surgical patient. The AORN guidelines offer evidence-based practice to standardize care and improve patient outcomes. The new ERAS guideline can be found in eGuidelines+, as well as the 2025 print guideline book and ebook.

AORN also offers a free comprehensive education and recognition program, Implementation of Enhanced Recovery After Surgery, through the AORN Center of Excellence in Surgical Safety initiative.