Research project aims to expand Enhanced Recovery After Surgery guidelines across Alberta

Turning evidence into everyday practice

Every year, thousands of Albertans recover from surgery longer than they need to. The evidence for faster, safer recovery already exists — the challenge is implementing it consistently in everyday care. 

Dr. Khara Sauro, PhD, associate professor in the departments of Surgery, Community Health Sciences, and Oncology at the Cumming School of Medicine, and lead of the Knowledge to Implementation (K2I) Lab, is addressing the challenge of post-surgical recovery head-on. Her newly funded Canadian Institutes of Health Research (CIHR) project is focused on advancing the adoption of Enhanced Recovery After Surgery (ERAS) guidelines across Alberta and improving patient outcomes. 

ERAS combines evidence-based steps, like better pain control, early nutrition, and getting patients moving sooner, to help people recover faster, reduce complications, and return home more comfortably. Studies show ERAS work: patients in ERAS programs experience fewer complications and leave the hospital two to eight days sooner than those receiving traditional care. Yet, despite this evidence, provincial adoption remains uneven. Average compliance hovers around 70 per cent, and some hospitals have yet to implement ERAS at all.

In collaboration with multidisciplinary surgical teams across Alberta, the K2I Lab is working to close this gap. Their goal is clear: to make ERAS a standard part of surgical care for every patient in Alberta, and to develop a scalable model that can be adapted nationally and internationally through their global network of collaborators.

Why implementation is at the centre of the work

In a Learning Health System, implementation isn’t an afterthought, it’s the engine that drives change. Dr. Sauro’s team is focused on understanding what makes ERAS adoption work in real hospitals with real teams, and how those lessons can be scaled across Alberta and beyond.

As outlined in the Learning Health System (LHS) framework, one of the components is implementation and reach, or the process of turning evidence into day-to-day practice. The K2I Lab’s work zeroes in on this idea by studying how to make ERAS adoption more consistent, scalable, and easier to integrate across diverse healthcare settings. 

The goal isn’t to prove that ERAS works as the evidence is already clear, but to uncover how it can work reliably, sustainably, and equitably in every hospital context.

Sustainable change begins with collaboration

From the outset, the K2I Lab has prioritized co-design by engaging multidisciplinary and multiprofessional healthcare providers who care for patients undergoing ERAS-guided surgeries. Their involvement will shape the implementation strategies for ERAS guidelines to ensure they are practical, relevant and grounded in frontline experiences. 

The project will implement a range of strategies in phased rollouts across participating hospitals. 

“The goal is to improve healthcare system performance and improve patient outcomes, [and] we hope when the study is done the processes will continue because they have been co-designed by end users,” says Dr. Sauro.

Given the diversity of participating sites — including large academic hospitals already using ERAS protocols and smaller community hospitals where ERAS is not yet in practice — the implementation strategies will be tailored to each setting. These adaptations will be carefully documented to allow for a nuanced analysis of what worked, where, and for whom. This approach not only supports local relevance but also strengthens the study’s ability to generate transferable insights across varied healthcare contexts.

Once the research phase concludes, the infrastructure created —such as data dashboards, audit-feedback mechanisms, and collaborative team processes — will remain active within participating hospitals. This ensures that facilities can continue improving independently, guided by evidence-based learning cycles.

Keeping equity in mind 

There is emerging evidence that ERAS guidelines can contribute to more equitable surgical care. Because these guidelines are grounded in evidence, they offer a framework for clinical decision-making that can help mitigate the influence of provider bias. However, as with much of health research, the evidence base itself is not immune to bias. Equity-deserving groups have historically been underrepresented in primary research, which means that the data informing clinical guidelines may not fully reflect the needs or experiences of all populations.

To address this gap, Dr. Sauro is collaborating with surgical colleagues who are also equity researchers to conduct a systematic review. This work explores how ERAS guidelines impact both outcomes and access to care across diverse patient populations. By integrating equity-focused inquiry from the outset, they aim to ensure that the benefits of ERAS are distributed fairly and inclusively.

What the future holds

Following the completion of the trial, the next goal is to scale and expand the most effective implementation strategies beyond Alberta. With an advisory committee that includes partners from across Canada and internationally, including collaborators from low-income countries, the project is well-positioned to adapt lessons learned to a variety of healthcare systems and resource settings. 

This expansion will allow the team to test how implementation approaches can be tailored to different contexts while maintaining their effectiveness and commitment to equity. Ultimately, the initiative aims to foster a culture of continuous learning, where hospitals not only adopt best practices, but also refine them through shared learning, data-driven feedback, and sustained collaboration.

To learn more about the Knowledge to Implementation Lab, visit their website.