Enhanced Recovery After Surgery

Stony Brook University Medical Center is a leader in Enhanced Recovery After Surgery (ERAS). ERAS is a multidisciplinary implementation of best practices in the preoperative, intraoperative, and postoperative phases designed to accelerate recovery, improve patient satisfaction, and reduce complications and resource utilization.

Stony Brook’s full-time ERAS Coordinator, Dr. Sunitha Singh, facilitates a multi-disciplinary team approach involving anesthesiologists, surgeons, nurse practitioners, physician assistants, nurses, pharmacists, and social workers.

Since inception at Stony Brook, our ERAS programs have stimulated important advances in clinical care and in research studies that advance the overall patient experience. Currently under the guidance of Dr. Elliott Bennett-Guerrero, a leading advocate for ERAS, these pathways are seeing rapid adoption within our healthcare system. Dr. Bennett-Guerrero is Professor of Anesthesiology and Vice Chair for Clinical Research and Innovation in the Department of Anesthesiology. He also serves as the Medical Director for Perioperative Quality and Patient Safety. Dr. Bennett-Guerrero’s extensive background in perioperative clinical research has garnered acclaim at the national level and he has secured significant funding for diverse quality improvement and clinical research projects. His expertise and novel concepts are a driving force to advancing ERAS initiatives.

Stony Brook Medicine currently has 10 ERAS specific pathways across 4 surgical departments:
  • Lumbar Spine Fusion
  • Colorectal
  • Surgical Oncology – Pancreas and Liver
  • Urology – Cystectomy
  • Bariatric
  • Gynecology – including Minimally Invasive, Uro Gyn and Gyn Oncology
  • Obstetric – C-Section
  • Orthopedic – Hip and Knee Joint Replacement
Since ERAS implementation, several improvements in care have been observed. A few of these include:
  • Reduced postoperative length, e.g. from 2-3 days to 1.7 days (or 8 hrs after Same Day Surgery) in Hip and Knee Replacement surgery
  • Minimized opioid prescriptions after discharge
  • Removed urinary catheters and epidurals in Hip and Knee Joint Replacement surgery
  • Improved timely splenectomy vaccinations for Surgical Oncology patients
We will be launching ERAS pathways in General Surgery, Cardiac and Thoracic surgery and are developing pathways for Vascular and Pediatric surgery.

Anesthesiology residents and other trainees are invited and encouraged to participate in ERAS program development and implementation. Our anesthesia residents have presented posters and have drafted manuscripts for results of ERAS in Minimally Invasive Gynecology and Spine surgery.

We continuously seek innovative ways to advance patient care. Some examples include:
  • Developing an IT-based automated system to monitor compliance and outcomes across all ERAS programs
  • Developed an automated system for collection of Patient Reported Outcomes (PROs) using emails and texts after hospital discharge
  • Developed a post-operative urinary retention protocol
  • Replaced patient-controlled analgesia with peri-articular joint infiltration
  • Adapted our Total Joint Replacement ERAS Program during the COVID-19 pandemic to provide ambulatory surgery
If you have any questions or would like to get involved, please contact Dr. Sunitha Singh (ERAS Coordinator) at Sunitha.Singh@stonybrookmedicine.edu

Select Publications
  • Smith J, Probst S, Calandra C, Davis R, Sugimoto K, Nie L, Gan TJ, Bennett-Guerrero E. Enhanced recovery after surgery (ERAS) program for lumbar spine fusion. Perioper Med (Lond). 2019 May 28;8:4
  • Singh SM, Liverpool A, Romeiser JL, Miller JD, Thacker J, Gan TJ, Bennett-Guerrero E. A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs. Perioper Med (Lond). 2021 May 28;10(1):19.
  • Singh SM, Liverpool A, Romeiser JL, Thacker J, Gan TJ, Bennett-Guerrero E. Types of surgical patients enrolled in enhanced recovery after surgery (ERAS) programs in the USA. Perioper Med (Lond). 2021 Apr 27;10(1):12
  • Kowa CY, Jin Z, Gan TJ. Framework, component, and implementation of enhanced recovery pathways. J Anesth. 2022 Jul 5
  • Schwartz J, Gan TJ. Management of postoperative nausea and vomiting in the context of an Enhanced Recovery after Surgery program. Best Pract Res Clin Anaesthesiol. 2020 Dec;34(4):687-700
  • Guinn NR, Schwartz J, Arora RC, Morton-Bailey V, Aronson S, Brudney CS, Bennett-Guerrero E; Perioperative Quality Initiative (POQI-8) and the Enhanced Recovery After Surgery-Cardiac Society (ERAS-C) Investigators. Perioperative Quality Initiative and Enhanced Recovery After Surgery-Cardiac Society Consensus Statement on the Management of Preoperative Anemia and Iron Deficiency in Adult Cardiac Surgery Patients. Anesth Analg. 2022 Sep 1;135(3):532-544
  • Romeiser JL, Cavalcante J, Richman DC, Singh SM, Liang X, Pei A, Sharma S, Lazarus Z, Gan TJ, Bennett-Guerrero E. Comparing Email, SMS, and Concurrent Mixed Modes Approaches to Capture Quality of Recovery in the Perioperative Period: Retrospective Longitudinal Cohort Study. JMIR Form Res. 2021 Nov 4;5(11):e25209
  • Spaniolas K, Nie L, Moller D, Tatarian T, Hesketh A, Yang J, Docimo S, Bates A, Gan TJ, Pryor A. A Comprehensive Approach for the Prevention of Nausea and Vomiting Following Sleeve Gastrectomy: a Randomized Controlled Trial. Obes Surg. 2020 Jun 25
  • Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, Jin Z, Kovac AL, Meyer TA, Urman RD, Apfel CC, Ayad S, Beagley L, Candiotti K, Englesakis M, Hedrick TL, Kranke P, Lee S, Lipman D, Minkowitz HS, Morton J, Philip BK. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020 May 27