Enhanced Recovery (ERAS)

What is Enhanced Recovery After Surgery (ERAS)?

Enhanced Recovery After Surgery (ERAS) is an evidence-based approach to care. The approach is designed to prepare patients for and reduce the total impact of surgery, supporting early recovery for patients.

Historically, following illness or surgery, rest was prescribed and eating and drinking withheld or restricted until normal bodily functions returned. Early return to normal activity and function was thought to be deleterious or even dangerous to a patient’s recovery. This care contributed to poorly controlled pain and prolonged immobility for patients.

These traditions were challenged when ERAS was first introduced.The new pathway included strategies to prepare patients for surgery, to optimise pain relief, reduce the surgical stress response, promote early mobilisation and was designed to empower the patient to regain independence as quickly as possible post-operatively. The approach was successful and has been confirmed as being able to improve clinical outcomes for patients and reduce length of hospital stay.

  • ERAS re-examines traditional practices
  • ERAS replaces traditional practices with evidence-based best practice
  • ERAS covers all areas of patient’s journey through the surgical process

Professor Middleton and Tom Wainwright were among the first people within the UK to implement ERAS within orthopaedics. Their implementations of ERAS at the Royal Bournemouth and Christchurch Hospital changed patient outcomes dramatically in 2007. Subsequently, this was published in 2010 and was the first report of ERAS implementation in the NHS. Since then this paper has been highly cited and has led to over 28 other ERAS publications.

Professor Rob Middleton and Associate Professor Tom Wainwright

Professor Rob Middleton and Associate Professor Tom Wainwright

ERAS UK presentation: Tom Wainwright “What prevents early mobilisation” 


Deputy Head of ORI Tom Wainwright