By Sarah Bello
ERAS, or Enhanced Recovery After Surgery, is a multidisciplinary care pathway that involves nearly every department within CMH. ERAS is designed to achieve early recovery for patients undergoing major abdominal surgery and represents a shift in perioperative care in two ways. First, it reexamines traditional practices and replaces them with evidence-based best practices that are used globally. Secondly, it is comprehensive in its scope and covers all areas of the patient’s journey through the surgical process — from the clinic, to nutrition, to physical therapy, to IT, to pre-op, intra-op and post-operative care.
Dr. Juliette Moore, general surgeon, saw ERAS instituted during her surgical residency and training and decided to bring it to CMH.
“It seemed like a perfect fit for this place,” Moore says. “It provides great results, quick turnaround in terms of recovery, great patient satisfaction and great outcomes.”
The key factors that keep patients in the hospital for a prolonged period after surgery include the need for medications administered through IVs, the need for intravenous fluids secondary to gut dysfunction, bed rest caused by lack of mobility and post-operative pain management.
The central elements of the ERAS pathway address these key factors, helping to clarify how they interact to affect the patient’s recovery. In addition, the ERAS pathway provides guidance to all involved in perioperative care, helping them to work as a well-coordinated team to provide the best care.
Before the implementation of ERAS at CMH, preoperative prolonged fasting, mechanical bowel preps and post-surgical nasogastric tubes were thought to be necessary to empty the bowel, prevent intraoperative contamination and to prevent early passage of bowel content through a suture line while it healed. A drain tube was believed to be essential to any major abdominal surgery, and urinary catheters were placed and maintained for multiple days after surgery. Prolonged post-operative hospital stays of five to seven days were the norm, and prolonged bed rest was recommended to facilitate abdominal wall healing.
With ERAS, we expect to see a reduction of the stress response to surgery, lower rates of organ dysfunction, reduced morbidity and reduced post-operative length of stay. In fact, strict adherence to ERAS reduces hospital stays to two to three days, decreasing costs to the patient. We also expect to see an enhanced patient experience due to not placing nasogastric tubes or drain tubes, early removal of urinary catheters, providing long-lasting local anesthetic to the surgical incisions and a quicker return to home and normal life.
We partnered with OHSU in defining our ERAS protocol at CMH. While we have used pieces of the protocol over the past few months to enhance patient experience and outcomes, our first patients who received the full impact of the ERAS protocol had their surgeries in March. So far, three patients have experienced the full ERAS protocol with their colorectal surgeries.
“All of them have had great outcomes so far,” Moore says. “All of them went home in less than three days, and in one case, one day, which is not the norm, but very exciting to see.”
So, Moore might say using ERAS is not your grandmother’s colorectal surgery. “This is your new, hip cousin’s surgery,” she says.
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