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World J Surg. 2018 Jul;42(7):1919-1928. doi: 10.1007/s00268-017-4436-2.

Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study.

Author information

Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 4AT, UK.
Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK.
Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Higher Kingston, Yeovil, Somerset, BA21 4AT, UK.
South West Surgical Training Network, ERAS-UK, Yeovil, Somerset, BA20 2RH, UK.
Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland.
NHS Lothian Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, Scotland.
Section of Surgical Pathophysiology 4074, Rigshospitalet, Blegdamsvej 9, 2100 Kbh Ø, Copenhagen, Denmark.
Head of Gastrointestinal Nurse Education, Academic Institute, St Mark's Hospital, London, HA1 3UJ, UK.
Strategic Clinical Networks, Alberta Health Services, Edmonton, AB, Canada.
Faculty of Nursing, University of Calgary, 10301 Southport Lane SW, Calgary, AB, T2W1S7, Canada.
Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 85, Orebro, Sweden.



Enhanced Recovery After Surgery (ERAS) is widely accepted in current surgical practice due to its positive impact on patient outcomes. The successful implementation of ERAS is challenging and compliance with protocols varies widely. Continual staff education is essential for successful ERAS programmes. Teaching modalities exist, but there remains no agreement regarding the optimal training curriculum or how its effectiveness is assessed. We aimed to draw consensus from an expert panel regarding the successful training and implementation of ERAS.


A modified Delphi technique was used; three rounds of questionnaires were sent to 58 selected international experts from 11 countries across multiple ERAS specialities and multidisciplinary teams (MDT) between January 2016 and February 2017. We interrogated opinion regarding four topics: (1) the components of a training curriculum and the structure of training courses; (2) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (3) a framework to assess the effectiveness of training; (4) criteria to define ERAS training centres of excellence.


An ERAS training course must cover the evidence-based principles of ERAS with team-oriented training. Successful implementation requires strong leadership, an ERAS facilitator and an effective MDT. Effectiveness of training can be measured by improved compliance. A training centre of excellence should show a willingness to teach and demonstrable team working.


We propose an international expert consensus providing an ERAS training curriculum, a framework for successful implementation, methods for assessing effectiveness of training and a definition of ERAS training centres of excellence.

[Indexed for MEDLINE]

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