Enhanced Recovery After Surgery (ERAS) Programs in Orthopedics

October 19, 2022


What is an Enhanced Recovery After Surgery (ERAS) program?

Joint Camp. Prehab. Fast-track. Rapid recovery program. We’ve even heard some patients coin the term “surgery school”. These are terms referring to programs designed to hasten recovery time, decrease length of stay, and reduce readmission rates, complications and procedural variability. Let’s talk about the big name you should know for total joint replacements: Enhanced Recovery Program (ERP) and Enhanced Recovery After Surgery (ERAS).

Collectively, there’s research that uses both terms (ERP vs ERAS), but with reference to orthopedics, the ERAS Society has pioneered research collection and establishes guidelines for developing, implementing, and maintaining effective, patient-centered, enhanced recovery protocols for every surgical specialty, including elective orthopedics– specifically hips, knees, and spine.

What does an effective ERAS program entail?

For starters, it goes beyond the standard pre-op education classes or materials. To be considered a true ERAS program, multiple systems and processes must be implemented across providers, including pre-op, intra-operative, and post-op interventions, like the ones outlined in this graphic

Table explaining Active Patient Involvement

So what does it really entail to have an ERAS program for an elective joint replacement? Pre-operatively an emphasis is placed on optimization. Providing a pre-op evaluation and first addressing any organ or lifestyle items (aka smoking cessation and managing those pesky pre-existing conditions such as hypertension, diabetes and cardiac conditions), introducing pre-op education with distinguished post-operative discharge planning, and discussing options for pre-op fasting, anesthesia and prophylaxis are among the most impactful. Intra-operatively surgical techniques should meet minimally invasive guidelines, maintain optimal fluid balances with minimal blood loss, and using regional anesthesia instead of general anesthesia to decrease insulin resistance. Post-operatively some of the highlights include using multimodal opioid-sparing pain management, prevention of post-op nausea and vomiting, early mobilization and initiation of physical therapy (recommended on post-op day 0, as early as 2-6 hours after the patient is stable).

What are the benefits of an ERAS program?

ERAS protocol adoption and utilization has surged throughout the world as the benefits of implementing ERAS protocols include: reduced postoperative complications, shorter length of hospital stay, decreased readmission rates, improved patient satisfaction, and accelerated recovery. For example, a  2019 study compared the cost of conventional perioperative care versus that of the ERAS protocol in patients who underwent minimally invasive spinal surgery and found an average a cost savings of $3,444 per patient, which equated to a greater than 15% cost savings per patient. In other words, ERAS programs  are paving the way towards reducing excess costs for both patients and facilities, while also promoting evidence-based care, value-based care, and improving patient outcomes.

So, if ERAS programs are so great, why are they not more popular?

Well, it would be ignorant to say that they’re easy to adopt, as they require a multi-faceted, multi-disciplinary approach to be effectively implemented. A “patient journey” must be mapped out and followed between each surgical provider, and moving the patient from pre-op to optimal discharge status requires everyone from surgery, anesthesia, nursing, physical therapy, dietary and nurse navigators/care coordinators to be on the same page about how patients are intended to progress. However, with continued slashing of physician reimbursement, increased implant costs, and new CJR/CMS requirements to report patient outcome data, the pressure to streamline surgical processes and decrease surgical/ post-operative costs without compromising patient outcomes is high. 

Adopting an ERAS-level program may take some effort on the front-end, but another critical component of success involves tracking patient outcomes to witness how effectively your program evolves! If there’s anything that the ERAS Society and we at CODE Technology love more than awesome patient outcomes, it’s the ability to track those outcomes as data points and analyze for quality improvement. So, if your organization has been looking for a way to aggregate data for CMS reporting requirements and is too busy to track the development of your ERAS program, CODE Technology can help! We provide you with the tools you need to track your outcomes without any additional work from your current providers. 


    1. Orthopaedics
    2. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations
    3. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations
    4. Current status of enhanced recovery after surgery (ERAS) protocol in gastrointestinal surgery
    5. Enhanced recovery pathways in orthopedic surgery
    6. Implementing enhanced recovery pathways to improve surgical outcomes
    7. CMS Proposes Rate Cuts in 2023 Medicare Physician Fee Schedule
    8. CJR Model Toolkit
    9. CMS Issues New THA/TKA PRO-PM in the FY 2023 Hospital IPPS

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Emily Pickup

About the Author

Emily Pickup  |  Client Outcomes Manager  |  Emily's background as a Physical Therapist in orthopedics inspired her to venture into the world of tracking patient data at a broad scale in order to help providers better understand their patients' experiences!