• Led by Manchester University NHS Foundation Trust, in partnership with the NHS Transformation Unit Manchester, Haelo and Health Improvement Manchester.
  • ERAS+, a proven pre- and post-surgery training programme, will be implemented in six NHS Trusts in Greater Manchester.
  • Initiative to improve recovery following major surgery and reduce post-surgical complications.

Post-operative pulmonary complications (PPC) affect 1–2% of patients following surgery. But in major surgery they are the most common significant complication and can affect up to 30% of patients. PPCs usually occur within the first seven days following surgery and typically manifest as an infection, an increase in oxygen needs or respiratory failure. PPCs lead to increased length of stay in hospital and reduced life expectancy for up to three years after surgery.

Enhanced Recovery After Surgery Plus (ERAS+) aims to better equip patients and their families for preparation and recovery from major surgery. It focuses on helping patients to prepare for and contribute towards the management of their own health care. It does this by addressing the physical and psychological stress associated particularly with cancer, but also helps to avoid chest complications which are common after surgery.

The initiative has been tested at Manchester Royal Infirmary with over 1,000 patients and has been shown to reduce PPCs by 50%, resulting in a three-day reduction in length of stay in hospital and annual savings of over £0.5m.

ERAS+ involves training to prepare for surgery, such as muscle training to increase strength, management of anaemia, and nutrition and lifestyle advice; use of the a respiratory care bundle and a stepped recovery programme in hospital; plus a structured exercise programme and focus on diet following surgery.

This Scaling Up Improvement project is implementing ERAS+ in six other NHS Trusts. It will become the standard pathway for every patient undergoing major surgery in Greater Manchester. This will mean up to 5,000 patients will benefit from the programme. Based on a one-day reduction in hospital stay, the initiative could save £1.5m.

The project will be independently evaluated and learning will help with sharing the programme further within the NHS in the future.

 

Five things you should know about ERAS+ 

  1. Enhanced Recovery After Surgery Plus (ERAS+) is a quality improvement programme that aims to better equip patients and their families to prepare and recover from major surgery. The programme is led by Manchester University NHS Foundation Trust and is being implemented on six further hospital sites in Greater Manchester.
  2. Post-operative pulmonary complications (PPC) can affect up to 30% of patients following major surgery, PPC can lead to increased length of stay in hospital and reduced life expectancy for up to three years after surgery. ERAS+ aims to reduce PPCs using specific prehabilitation and rehabilitation techniques such as incentive spirometry.  
  3. ERAS+ involves a package of training to prepare for surgery, such as an exercise programme; nutrition and lifestyle advice; use of a respiratory care bundle and a stepped recovery programme in hospital. This is all communicated to patients in a Surgery School ahead of their stay in hospital. 
  4. Before being part of Scaling Up Improvement Round 3, ERAS+ was tested at Manchester Royal Infirmary with over 1,000 patients and has been shown to reduce PPCs by 50%, resulting in a three-day reduction in length of stay in hospital. An evaluation at the end of the Scaling Up Improvement implementation aims to demonstrate similar benefits across the six new hospital sites. 
  5. Key learning from ERAS+ has helped to develop a specific Prehab4Cancer programme in Greater Manchester, providing exercise support for patients affected by cancer to prepare them for surgery and living beyond cancer. 

Contact details 

For further information about the project, please email Dr John Moore, Consultant in Anaesthetics and Critical Care, Adult Critical Care Clinical Director, Manchester Royal Infirmary, Manchester University NHS Foundation Trust or the following contacts for specific areas: 

About this programme

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Scaling Up Improvement

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