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A Shorter Path to Recovery Enhanced Recovery After Surgery (ERAS) By Ratna Swaminathan Consider this. You’ve been anesthetized, operated upon, awakened with minimal pain and are ready to start eating, drinking, and even walking on the Timothy E. Miller, day of surgery! Your MB ChB, FRCA overall hospital stay is shortened by two to three days and you resume your daily activities earlier than expected after major surgery. Early recovery is what most patients desire. At Duke University Medical Center, anesthesiologists are gaining significant progress to help make that happen. In fact, they’re ahead of the curve in helping patients who undergo abdominal surgery return to normal function more quickly. With patient contact throughout the perioperative setting, anesthesiologists find themselves in a unique position to have significant input in the enhanced recovery of their patients. Leading these efforts is Interim Chief, Division of General, Vascular, Transplant and Critical Care Medicine, Timothy E. Miller, MD. He has been successful in implementing a multimodal practice, fittingly called 32
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Enhanced Recovery After Surgery (ERAS). These Enhanced Recovery Programs (ERPs) have the patient’s best interest in mind. They integrate the best perioperative interventions which have been proven to maintain physiological function to facilitate postoperative recovery after a patient undergoes major surgery. The ERAS protocol follows an evidenced-based structured perioperative regime and uses less invasive surgical techniques, such as laparoscopy. If need be, doctors may also recommend to avoid an operation and instead perform a different clinical treatment method, such as radiation therapy or chemotherapy, explains Dr. Miller. The idea behind these ‘fast-track’ surgery pathways is to accelerate postoperative recovery and reduce morbidity after major surgery. The future of perioperative medicine, says Dr. Miller, will need greater partnerships between anesthesia, surgery, nursing and other providers to improve healthcare delivery (Figure 1). It starts with the pre-operative counseling of the patient, management during the surgery and increased efforts postoperatively for enhanced recovery. Dr. Miller explains, “It attenuates stress response and increases patient participation preoperatively and
Duke University Hospital Operating Room
during the recovery period.” Recovery after anesthesia and surgery is a complex process contingent on patient, surgical and anesthetic factors, as well as the presence of any adverse pre-existing conditions. Evidence suggests that some patients experience a functional decline after major surgery. It could take up to several months before patients regain their ability to perform activities as they could prior to surgery. Dr. Miller says, “The ERPs encourage early feeding and mobilization after surgery to reduce this dip in function so patients are ready to leave the hospital and return to normal life earlier after major surgery. The ERPs also use less lines and tubes than traditional surgery, which all patients prefer!” This is how it works (Figure 2): Patients Figure 1. The ERAS Inter-Disciplinary Team
Surgeon Anesthesiologist Nusing Staff Physical Therapist Nutritionist Social Worker Patient Educator/ Liaison ADAPTED FROM: Nanavati, A. J., & Prabhakar, S. (2014). Fast-track surgery: Toward comprehensive peri-operative care. Anesthesia, Essays and Researches, 8(2), 127–133. doi:10.4103/0259-1162.134474
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