Enhanced recovery after surgery: what ERAS is and how it works
ERAS protocols have changed joint replacement worldwide. Here is what they involve and why they are both a medical and a management task.
What ERAS is
ERAS (Enhanced Recovery After Surgery) is a set of coordinated measures before, during and after surgery that reduce stress on the body and speed up recovery. For hip and knee replacement, the international ERAS Society has published consensus recommendations [1].
What the protocol includes
- preparing and educating the patient before surgery, so they know what to expect;
- modern anaesthesia and pain relief using several methods to reduce the need for strong drugs;
- prevention of blood clots, nausea and blood loss;
- early mobilisation — first steps on the day of surgery or the next day;
- clear discharge criteria rather than a fixed number of days.
A systematic review showed that early mobilisation after joint replacement shortens hospital stay [2]. Length of stay varies widely between countries: in England, for example, the median is about three days [3].
Why it is also a management task
The protocol only works when the surgeon, anaesthetist, nurses and rehab instructor act as one team to one standard. So ERAS is also about organising processes: theatre schedules, access to rehabilitation and clear instructions for patients.
How we do it
At Gavhar Clinic the operating theatres, intensive care, wards and rehab gym are in one building. We aim to get patients up the next day, and discharge depends on how confidently they walk with support. On average the hospital stay is about five days, including monitoring in intensive care.
Sources
- Wainwright TW, Gill M, McDonald DA, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthopaedica, 2020;91(1):3–19. doi.org
- Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clinical Rehabilitation, 2015;29(9):844–854. unisa.edu.au
- French JMR, et al. Length of stay after hip and knee replacement in England. BMC Medicine, 2025. doi.org
This article is based on scientific publications and clinical guidelines. It does not replace a consultation with a doctor.
