Experiences with Implementing a Nationwide Enhanced Surgical Recovery Program


Program Description / Statement of Need:

In this online CME self-learning program:


There are a multitude of strategies a healthcare organization may adopt to improve its surgical quality standards, chief among them enhanced recovery pathways (ERPs) or enhanced recovery after surgery (ERAS) practices, which encompass myriad components. These components include a variety of what have traditionally been interspersed into different areas of specialty: antisepsis and infection control, patient warming, glucose control, multimodal pain control, nausea control, fluid and nutrition therapy, and many others, not to mention ensuring that all of these aspects continue uninterrupted while the patient transitions throughout all levels of care. These pathways are designed to attenuate the stress response during a patient’s surgical procedure and preserve organ function while promoting early recovery.  While this approach is not new, it has not always been widely employed in spite of supporting evidence from a range of randomized controlled trials, systematic reviews, and meta-analyses.  This literature suggests that ERAS programs are safe, cost-effective, and minimize the length of stay in a hospital without compromising quality of care. ERAS programs are successful in part because they are proactive in nature, comprised of interventions beginning during preoperative planning and continuing through intraoperative management and postoperative care.


Dr. Monty Mythen shares his experiences in the United Kingdom, what the United States and the rest of the world has begun to adopt, and where we still have left to go.




  • Elective surgery as a global public health concern
  • Case study: colorectal length of stay in 2000 vs. 2008
  • The UK experience: reduction in length of stay: hip, knee, and hysterectomy (abdominal and vaginal) breaking down the silos, freeing up the beds
  • The benefits: increased productivity, increased quality, increased patient satisfaction, reduced cost
  • UK to the US: The Declaration of ERAS
  • The three pillars of ERAS: minimally invasive surgery, pain management, fluid management
  • An enhanced recovery pathway (ERP) litmus test: drinking, eating, mobilizing
  • The fundamental dangers of hypovolemia, hypervolemia, and salt-loading – and how conventional experience often gets us there
  • Fluid utilization on the day of surgery in colorectal surgery
  • Present gaps


Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

Program Objectives:

By the end of the session the participant will be able to:

    • Identify the three pillars of enhanced recovery after surgery (ERAS)
    • Describe the average, elective colorectal post-operative surgical patient in a successful enhanced recovery (ERAS) program
    • Describe the effects of fluid restriction, overload, and optimization in the setting of colorectal surgery
    • Design a best-practice, day-of-surgery, fluid-management program based on the experience of other institutions


    This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.


    Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Release Date: September 12, 2015
    Expiration Date: September 12, 2017

    Faculty: Monty Mythen MD

    Faculty Disclosure and Resolution of COI:

     As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved through  content review ScientiaCME.


    Faculty Disclosure:

    Dr.  Monty Mythen, MD discloses that he is a consultant / speaker for Edwards Lifesciences and Deltex.


    Disclosures of Educational Planner: Charles Turck, PharmD is an officer and part owner of ScientiaCME, LLC, which has received a grant from the commercial supporter of this program: Edwards Lifesciences .


    Commercial Support Disclosure: This program is supported by an educational grant from Edwards Lifesciences 


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    -Read the learning objectives and faculty disclosures above

    -Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.

    -View the on-line program. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.

    -Take the post-test

    -Complete the program evaluation and CME registration. A CE certificate will be emailed to you.

    Perform Pre-Test (optional)
    Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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    View the on-line program


    Perform Post-Test

    Complete the Symposium Evaluation and Request CE Certificate

This program is supported by Educational Grants from Edwards Lifesciences.