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CION Cancer Clinics
What is enhanced recovery after surgery, and what will it ask of you? | CION Cancer Clinics
ERAS, or enhanced recovery after surgery, is a planned set of small care steps before, during and after an operation. Shorter fasting, gentler pain relief, early eating, early walking and taking tubes out sooner all work together to help you recover with fewer problems. This page explains each step, what you and your family will be asked to do, and who may need a slower plan. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is ERAS, in plain words?
- What does ERAS change at each stage?
- What will you be asked to do yourself?
- How is ERAS different from the older way of recovering?
- Isn't it too early? What families usually worry about
- What do the ERAS terms mean?
- Who may not follow the full ERAS plan, and what should you ask?
- Common questions about ERAS
The short answer
What is ERAS, in plain words?
ERAS, or enhanced recovery after surgery, is a planned set of small care steps before, during and after an operation. Together they aim to help you get up, eat and go home sooner, with fewer problems along the way.
It is a way of working, not a machine or an operation
No single step in ERAS is dramatic. Shorter fasting before surgery. Pain relief that relies less on strong morphine-type medicines. Eating and walking early. Taking out tubes as soon as they are no longer needed. Each step on its own makes a small difference. Done together, and done by the whole team, they add up.
Why you are asked to do so much, so soon
Lying still in bed for days weakens the muscles, slows the bowels, raises the chance of a chest infection and of blood clots in the legs. ERAS turns that around. It asks you to be an active part of your own recovery from the first day. That can feel surprising, even unkind, to a family expecting complete rest. It is done because rest in bed carries its own harms.
ERAS is used for many kinds of operation, including bowel, gynaecological, urological, liver and some head and neck surgery. Ask your centre whether it follows an ERAS pathway for your operation.Before, during, after
What does ERAS change at each stage?
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Weeks before: getting fitter
You may be asked to walk daily, stop smoking, cut down alcohol, eat more protein and practise breathing exercises. The team explains the plan so you know what to expect after waking.
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The night before and the morning
Fasting is kept as short as is safe. Some people are given a clear sugary drink a few hours before surgery. People with diabetes follow the team's separate instructions.
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In the operating theatre
The anaesthetist aims for pain relief with fewer side effects, often using a nerve block or epidural. You are kept warm and given measured fluids. Smaller cuts are used where the surgeon judges them suitable.
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The first days after
Sips and light food early. Sitting in a chair and walking with help. The urine catheter and drains come out as soon as they are no longer useful.
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Going home
You go home when you meet clear checks, not on a fixed day. You leave with a number to call and a plan for the first review.
Not sure whether this applies to you?
Ask an oncologistYour part in it
What will you be asked to do yourself?
ERAS works only if the patient and family take part. These are the things the ward will ask of you.
Get out of bed
Sit in a chair and take short walks with a nurse or physiotherapist, often from the first day. Longer walks each day after that.
Breathe deeply and cough
Deep breaths and gentle coughing keep the lungs open. Hold a folded towel or pillow against the wound while you cough.
Eat and drink when allowed
Start with sips, then small, frequent meals. Chewing and eating early help the bowels wake up.
Say how much it hurts
You will be asked to score your pain. Be honest. Pain that stops you breathing deeply or walking needs better control, not endurance.
What the family can do
Encourage walking rather than rest. Do not bring food unless the nurse agrees. Help the patient keep a simple daily note.
Worth noting each day
- Walks taken
- What was eaten and drunk
- Pain and sleep
Side by side
How is ERAS different from the older way of recovering?
The older approach
An ERAS approach
Nothing to eat or drink from the night before
Fasting kept as short as is safe
Long bed rest after the operation
Sitting up and walking early, with help
Food held back until the bowels open
Fluids and light food early, where safe
Tubes and drains left in routinely
Tubes removed once no longer needed
Going home on a set day
Going home when clear checks are met
Common worries
Isn't it too early? What families usually worry about
"Walking so soon will open the stitches."
The wound is closed in layers made to hold during normal movement. Walking with support does not usually strain it. Supporting the wound with a pillow when you cough or get up makes it feel safer.
"After a big operation he should rest in bed for a week."
Long bed rest raises the chance of chest infections, clots in the legs and weak muscles. Rest still matters, in between short walks. The aim is movement little and often.
"Being sent home early means they want the bed."
In an ERAS pathway, going home depends on clear checks such as eating, walking and pain controlled with tablets. If those are not met, you stay. Recovery often continues more comfortably at home than on a ward.
"If I follow ERAS, nothing can go wrong."
ERAS lowers the chance of some problems. It is not a promise. Complications can still happen, and when they do, the plan changes to deal with them first.
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Words you may hear
What do the ERAS terms mean?
- Prehabilitation
- Getting fitter before the operation through walking, breathing exercises and better nutrition.
- Carbohydrate drink
- A clear sugary drink some people take a few hours before surgery, so the body is not starved going in.
- Multimodal pain relief
- Using several kinds of pain relief together, so less of any one strong medicine is needed.
- Early mobilisation
- Getting out of bed and walking soon after the operation, with help.
- Discharge criteria
- The checks you need to meet before going home, such as eating, walking and managing pain on tablets.
Being straight with you
Who may not follow the full ERAS plan, and what should you ask?
Not everyone can follow every step. The plan is adjusted to the person, and a change to it is not a sign of poor care.
When the plan is usually changed
Emergency operations leave little time for preparation. People who are very frail, who have serious heart or lung disease, or who go to the ICU after surgery often move more slowly. People with diabetes may not be given the sugary drink. After food pipe, stomach and some head and neck operations, eating by mouth may start much later. If a complication happens, treating it comes before any step on the checklist.
What this page cannot tell you
It cannot tell you how many days you will stay, or whether your own centre uses an ERAS pathway for your operation. Pathways differ between hospitals and between operations.
Questions to take to your surgeon
Do you follow an enhanced recovery plan for this operation? How long should I fast, and can I have a drink before surgery? Will I have a nerve block or epidural? When will I be expected to walk and eat? What checks do I need to meet before going home? Should I do anything in the weeks before the operation?
Questions we are asked
Common questions about ERAS
Does ERAS mean I will go home sooner?
Often, but not always. Going home depends on meeting clear checks such as eating, walking and pain controlled with tablets. Some people meet them quickly and some take longer. A slower recovery is not a failure of the plan. It means the team is waiting for your body to be ready.
Is ERAS only for keyhole surgery?
No. ERAS steps are used after open operations as well as keyhole ones. Smaller cuts can help, but most of the benefit comes from the other steps: shorter fasting, good pain relief, early eating and early walking. Ask your surgeon which kind of operation is planned and why.
Can I really drink something on the morning of surgery?
Some people are allowed clear fluids or a sugary drink until a set time before surgery. The exact time is given by your anaesthetist and depends on your operation and health. Follow the written instruction you are given. Do not decide the timing yourself, because it affects your safety under anaesthesia.
Will I be in pain when I walk the next day?
Some discomfort is expected. The pain relief plan is designed so you can move, breathe deeply and cough. If pain stops you walking or breathing properly, tell the nurse. That is a reason to adjust your pain relief, not a reason to stay in bed.
My father is elderly. Is ERAS safe for him?
Age alone does not rule it out, and older people often gain a lot from getting up early. The team adjusts the pace to his fitness, memory and other illnesses. Tell them about any falls, confusion or heart and lung problems before the operation so the plan fits him.
What can the family do to help?
Encourage short, regular walks. Help with breathing exercises. Offer drinks and small meals when the nurse allows. Keep a simple note of what was eaten, how far the patient walked and how the pain was. Avoid insisting on complete bed rest, however kindly meant.
Do I still need to do prehabilitation if my surgery is soon?
Even a short time helps. Walking every day, stopping smoking, eating enough protein and practising deep breathing all count. Ask your team what is realistic before your date. Do not delay a planned cancer operation to get fitter unless your surgeon suggests it.
What if I cannot keep up with the plan?
Tell the nurse or physiotherapist. The plan is a guide, not a test. If you feel dizzy, breathless or too sick to walk or eat, the team needs to know so they can find out why and adjust things. Pushing through warning signs quietly is not what ERAS asks of you.
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Sources
- NICE — Perioperative care in adults (NG180)
- Macmillan Cancer Support — Surgery
- Cancer Research UK — Surgery for cancer
- National Cancer Institute — Surgery to treat cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
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