Health care professionals

ERAS+ is an evidence-based surgical pathway developed in the NHS by healthcare experts and previous patients to help people recover more quickly and safely following major surgery. The programme has been developed at Manchester University Foundation Trust and has been successfully implemented in over 2000 major surgical patients.

Implementing ERAS+

Key goals have been identified as:

  • To reduce the incidence of PPC
  • Promote shared decision making in preparing for and recovering from surgery
  • Improve patients' physical and psychological well-being before and after surgery
  • To educate both professional groups and patients in preparation for surgery

ERAS+ 6 must do's

Step 1

Get Active

Work with the patient to assess their current level of fitness and set targets of completing 30 minutes of aerobic exercise daily such as walking, jogging, swimming or cycling. Encourage patients to make use of their local leisure facilities during preparation and recovery from surgery.

Step 2

Chest Training

Patients are advised of the increased risk of respiratory complications with major surgery. The basic effect of surgery and anaesthetic on patients’ lungs is explained to patients and their families and they are then walked through the elements of the respiratory bundle (ICOUGH) which aims to minimise these effects and, in turn, reduce respiratory complications.

Step 3

Muscle Strengthening

Patients with low functional baseline, particularly in the context of cancer, may feel excluded and unable to ‘exercise’. Activities should be advised with the intention that they be ‘user friendly’ and involve family support at relative low cost such as walking, swimming, gardening, cycling.

Step 4

Surgery School

Surgery School focuses on selected areas we believe have the greatest impact on patient recovery and those that have been highlighted by previous patients as important to them. A multi-disciplinary team approach is used with medical, physiotherapy and nurse colleagues giving short presentations with a focus on the key elements of ERAS+.

Step 5

Live Well

Patients are encouraged to embark on smoking cessation, reduce alcohol consumption, stay active and consume a nutritious, balanced diet. Discuss managing anaemia before surgery.

Step 6

Eat Well

Nutrition risk screening aims to increase awareness and allow early recognition and treatment. To be efficient, screening should be brief, inexpensive, highly sensitive and specific to the patient. For this purpose BMI (body mass index), weight loss, and an index of food intake may be obtained directly, or via validated nutrition screening tools. An insufficient diet leads to chronic malnutrition. To maintain a stable nutritional state, the diet has to meet the patient’s energy requirements.


Testimonials from the team

Mr Thomas Satyadas

Consultant Hepato-Biliary Surgeon

Nikki McGill

Clinical Lead Physiotherapist - Critical Care & General Surgery

Dr Daniel Conway

Consultant in Anaesthesia and Critical Care

Donna Cummings

Lead Nurse in Clinical & Scientific Services

Dr Claire Moore

Consultant in Anaesthesia

Dr Dan Nethercott

Consultant in Anaesthesia

Dr Natalie Thomas

Specialty Trainee Intensive Care Medicine

Dr John Moore

Consultant in Anaesthesia and Critical Care

Neil Bibby

Senior Specialist Hepato-Biliary Dietitian

Neetu Bansal