Surgery Journey
Enhanced Recovery After Surgery: Your Part in Healing Faster
Enhanced Recovery: Your Part in Healing Faster
Enhanced Recovery After Surgery (ERAS) is a set of proven measures used before, during, and after your operation to reduce the physical stress of surgery and help you recover sooner. Many of these measures depend on what you do. ERAS works best when you understand what is being asked of you, and why.
Your Five Commitments
Patients on an enhanced recovery pathway are asked to make five commitments:
- Stop all tobacco before surgery, and stop or reduce alcohol as advised.
- Follow the fasting and medicine instructions exactly, and tell the team about every medicine you take, including injections and supplements.
- Tell the team early about pain, nausea, or worries.
- Get up and walk when the team helps you to.
- Know the warning signs, and whom to call, after you go home.
Preparing Your Body in the Weeks Before Surgery
- Eat regular meals that include protein. Tell the team if you have lost weight without trying; your blood count is checked before the operation, and low blood count or poor nutrition can be treated first.
- Stop smoking: cigarettes, shisha, and vaping. Ideally stop at least 4 weeks before surgery. Stopping closer to the operation is still worthwhile, so stop now.
- Alcohol: you will be asked to stop before surgery. If you drink heavily every day, tell the team how much first, because stopping suddenly can be dangerous and may need medical supervision.
- Stay active with a daily walk. There is no single exercise programme that suits everyone, but general activity helps.
- Do not stop any medicine unless the team tells you to. They will tell you which medicines to stop and which to continue.
Recovery in Hospital: Eating, Drinking and Moving
- Eating and drinking: most patients can sip fluids within hours of surgery and start light food the same day or the next, unless the team tells you otherwise. Early feeding helps the bowel recover.
- Getting up: the team will help you sit out of bed and walk on the day of surgery, as soon as it is safe. After major surgery, aim to spend at least 3 hours out of bed each day from the first day after surgery. Walking protects your lungs, prevents blood clots, and wakes up your bowel. Short, frequent walks are better than one long one.
- Breathing exercises: take 10 slow, deep breaths every hour while you are awake, and cough while supporting your wound with a pillow.
- Fewer tubes: drains, stomach tubes, and urinary catheters are avoided unless needed, and removed early, because tubes limit movement and add infection risk.
- Clot prevention: walking and drinking enough help prevent blood clots. Depending on your risk, you may also be given a blood-thinning injection and fitted stockings or leg pumps.
- Nausea prevention: medicines are given during and after the operation to prevent sickness, so that you can eat and walk sooner.
Pain and Comfort After Surgery
Pain control uses several medicines that work in different ways, so each can be used at a lower dose: usually regular paracetamol, an anti-inflammatory medicine when it is safe for you, and numbing medicine around the wound or a regional block. Strong opioid painkillers are kept for breakthrough pain, and used for the shortest time needed, because they cause drowsiness and constipation.
Pain medicines are given on a schedule so that pain does not build up. Pain that stops you from walking, coughing, or sleeping is a reason to ask for more help, and the team would rather you said so early. You are not being a nuisance.
When the Pathway Is Adjusted
Enhanced recovery is a framework, not a rigid protocol. If you are frail, your surgery is an emergency, or you have significant heart, lung, or kidney disease or take blood thinners, parts of your pathway will be changed. Your team will explain which parts change and why, so your care is not a surprise when it differs from this guide.
Full guide written by Dr. Tamer Elalfy