Enhanced Recovery After Surgery Plus (ERAS+) Manchester University NHS Foundation Trust

Postoperative pulmonary complications (PPC) are one of the most common complications that arise from major surgery, representing a major healthcare challenge in terms of increased death rates and length of stay (LOS) in hospital.

Enhanced Recovery After Surgery Plus (ERAS+) is a proven pre- and post-surgery training programme that places patients at the centre of their own recovery from major surgery. It was initially implemented with over 1,000 patients at Manchester Royal Infirmary, reducing PPC by 50% and LOS by three days, as well as delivering annual savings of over £0.5m.

This Manchester University NHS Foundation Trust-led project aimed to replicate these benefits in six other NHS Trusts within the Greater Manchester region during a two-year period from 2018 to 2020.

The main elements of ERAS+ delivery included: physical exercise, lifestyle advice, and nutritional and well-being support; a respiratory care bundle and stepped recovery programme in hospital; and a ‘surgery school’ multidisciplinary educational platform for patients and carers, supported by the ERAS+ website and app.

Available results have demonstrated a consistent reduction in PPC and LOS (mean 3.1 days) following major surgery, without a consequent increase in hospital readmissions. This has generated patient, cost, hospital, system-level and national benefits of particular importance in the context of NHS surgical activity needing to return to pre-COVID-19 levels.  

Although resistance to change was a key challenge, hospitals were keen to collaborate and share data, which provided real benefits in terms of improving transparency and best practice. Project follow-up will support national rollout and investigate what facilitates long-term behaviour change and ongoing patient focus on healthy lifestyle.

Contact details 

For further information about the project, please contact Dr John Moore, Consultant in Anaesthetics and Critical Care, Manchester University NHS Foundation Trust.