New post-op recovery techniques, introduced in Europe and now being adopted in many hospitals across the U.S., have made dramatic improvements in how fast patients recover from a major operation, including hip or knee replacement, heart, colorectal and abdominal surgery.
Experts say these new procedures — called enhanced recovery after surgery (ERAS) — not only speed healing with fewer complications, but also result in patients' having less pain and spending less time in the hospital. A study of colorectal patients at the University of Virginia Medical Center, published in April in the Journal of the American College of Surgeons, found that following ERAS procedures cut hospital stays for patients by more than two days, decreased the complication rate by 17 percent and increased patient satisfaction with pain control by 55 percent.
In many ways, the ERAS guidelines upend the traditional way of preparing and caring for surgical patients. The changes, pioneered in Europe in the early 1990s, include keeping patients hydrated by giving them a special carbohydrate-loaded drink up to two hours before surgery, controlling their pain better with nonnarcotic pain relievers taken before the operation begins, and letting them walk and eat solid food soon after surgery.
The result, says Harvard Medical School professor Sharon K. Inouye, M.D., is that "patients will regain independence and quality-of-life much more quickly." It may even help older patients avoid a nursing home stay, she adds.
Inouye, a gerontologist and director of the Aging Brain Center in Boston, says helping patients recover faster also can help the health care system save money. In the Virginia study, for example, hospital costs were reduced by as much as $7,129 per patient. Considering that adults age 45-plus account for 75 percent of the most frequently performed surgeries each year, the savings could be substantial.
Here are some of the key elements of ERAS (there are about 20 care elements, which you can read more about at The ERAS Society). Ask your doctor about them if you have a major surgery scheduled.
Encouraging more fluids
Traditionally patients were told not to eat or drink after midnight before surgery in order to empty the stomach, so they wouldn't vomit while under general anesthesia. But what happens to your body while you're starving it? "If you're not eating, your body is getting its nutrition by breaking down your own body," says University of Washington professor of surgery David Flum, M.D. It turns out that we need energy to sustain ourselves after surgery, but energy comes from glycogen, which is stored in the liver and is depleted while fasting. The new recommendations allow patients to eat solids up to six hours before surgery and to drink clear liquids containing electrolytes and carbohydrates up to two hours before surgery to aid in recovery.
Premedicating with nonnarcotics
In addition to being potentially addictive, postoperative narcotic painkillers can complicate recovery by slowing bowel function and causing dizziness. And a dizzy patient may be more inclined to fall, which Flum says can cause a "spiral of decline." The ERAS recommendations include analgesic pain medications given before surgery as well as nonnarcotic pain relief delivered by catheter directly into the surgical site.
Getting out of bed within 24 hours after having major surgery may seem counterintuitive, but in fact it's better for you than bed rest. "Immobility is tremendously hazardous to the health and postoperative recovery of older patients," says Harvard's Inouye.
Standing and walking around soon after surgery helps patients use their lungs more, which in turn can help prevent pneumonia. It also helps patients regain bowel function more quickly and can reduce the need for pain medication.
Renee Bacher is a health writer in Baton Rouge, La. She last wrote for the Bulletin about vaccinations.
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