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

Francis, Nader K; Walker, Thomas; Carter, Fiona; H�bner, Martin; Balfour, Angela; Jakobsen, Dorthe Hjort; Burch, Jennie; Wasylak, Tracy; Demartines, Nicolas; Lobo, Dileep N.; Addor, Valerie; Ljungqvist, Olle


Nader K Francis

Thomas Walker

Fiona Carter

Martin H�bner

Angela Balfour

Dorthe Hjort Jakobsen

Jennie Burch

Tracy Wasylak

Nicolas Demartines

Professor of Gastrointestinal Surgery

Valerie Addor

Olle Ljungqvist


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 chal-lenging 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 select-ed international experts from 11 countries across multiple ERAS specialities and multidisci-plinary teams (MDT) between January 2016 and February 2017.
We interrogated opinion regarding 4 topics: (i) the components of a training curriculum and the structure of training courses; (ii) the optimal framework for successful implementation and audit of ERAS including a guide for data collection; (iii) a framework to assess the effective-ness of training; (iv) criteria to define ERAS training centres of excellence.

An ERAS training course must cover the evidence-based principles of ERAS with team ori-enated training. Successful implementation requires strong leadership, an ERAS facilitator as well as an effective MDT. Effectiveness of training can be measured by improved compli-ance. 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.


Francis, N. K., Walker, T., Carter, F., Hübner, M., Balfour, A., Jakobsen, D. H., …Ljungqvist, O. (2018). Consensus on Training and Implementation of Enhanced Recovery After Surgery: A Delphi Study. World Journal of Surgery, 42(7), 1919–1928.

Journal Article Type Article
Acceptance Date Dec 4, 2017
Online Publication Date Jan 4, 2018
Publication Date 2018-07
Deposit Date Dec 13, 2018
Publicly Available Date Jan 5, 2019
Journal World Journal of Surgery
Print ISSN 0364-2313
Electronic ISSN 1432-2323
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 42
Issue 7
Pages 1919–1928
Public URL
Publisher URL
Additional Information This is a post-peer-review, pre-copyedit version of an article published in World Journal of Surgery. The final authenticated version is available online at:


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