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CME: Enhanced recovery after surgery (ERAS) and optimizing perioperative care: therapeutic updates, best practices, and barriers to care


Activity Description / Statement of Need:

In this online CME self-learning program:


Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway 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 postpostoperative care.




Brief history of ERAS [Learning Objective #1]

  • Main philosophy-reduce metabolic stress and support the return of functions
  • Henrik-Kehlet proposal of a multimodal approach

ERAS Fundamentals key factors that keep patients in the hospital

    • Need for parenteral analgesia
    • IV fluids secondary to persistent gut dysfunction
    • Bed rest caused by lack of mobility
  • Key elements of ERAS
    • Pre-admission information and counseling
    • Attenuation of endocrine and inflammatory response
    • Preservation of organ function
    • Minimally invasive methods
    • Maintenance of homeostasis

Disadvantages of conventional care and advantages of ERAS

Preoperative ERAS [Learning Objective #1 and 2]

  • Education and counseling
  • Optimization
    • Fluid and carbohydrate loading, no prolonged fasting, no/selective bowel preparation, antibiotic prophylaxis, thromboprophylaxis, no premedication

Intraoperative ERAS [Learning Objective #1]

  • Surgical Techniques and considerations

Postoperative ERAS [Learning Objectives #1 and 3]

  • Optimal pain management strategy: opioid-sparing techniques, IV acetaminophen and NSAIDS, iontophoretic transdermal systems, available opioid products
  • Nutrition: high-calorie drinks, alvimopan, and mobilization
  • Management of drains, tubes, and lines

Challenges facing the adoption of ERAS [Learning Objective #4]

  • Resistance to change in practice
  • Necessity of dedicated resources
  • Practice of ERAS still varies between different health care practitioners and in different areas

Target Audience:

Patients and health care professionals who practice in the surgical and perioperative settings, including those in the following disciplines: surgery, anesthesiology, physician assistants, nurse practitioners, pharmacy, nursing, nutrition, and any other healthcare professionals with an interest in ERAS programs.

This program is supported by an educational grant from Mallinkdrodt and Abbott Nutrition.

Release Date: February 05, 2018 -- Expiration Date: February 05, 2020

Faculty: Kyle Cologne, MD


Learning Objectives

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

  • List the primary components of optimal ERAS programs
  • Describe strategies to in ERAS programs to optimize gastrointestinal recovery and apply them to patient cases
  • Describe optimal pain management strategies in ERAS programs and apply them to patient cases
  • Summarize the challenges facing the adoption of ERAS programs and discuss strategies to ameliorate them



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 thru content review ScientiaCME.


Faculty Disclosure:  Kyle Cologne, M.D., Assistant Professor of Colorectal Surgery Department Of Surgery / Colorectal Division Keck School Of Medicine, University Of Southern California Los Angeles, CA, has no relevant conflicts of interest to disclose.


Faculty DOES NOT plan to discuss off-label or investigational uses of a commercial product.


Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, has no relevant conflicts of interest to disclose.


Commercial Support Disclosure: This program is supported by an educational grant from Mallinkdrodt and Abbott Nutrition


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

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.