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 £0.5 million.

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 will implement 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 £1.5 million.

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

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