{"id":10091,"date":"2017-04-11T13:00:59","date_gmt":"2017-04-11T19:00:59","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=10091"},"modified":"2024-12-23T15:04:12","modified_gmt":"2024-12-23T22:04:12","slug":"surgery-prep-recovery-poised-revolution","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/surgery-prep-recovery-poised-revolution\/","title":{"rendered":"Surgery prep, recovery poised for revolution"},"content":{"rendered":"
<\/div>

Enhanced Recovery After Surgery, designed to better prepare patients for surgery and speed their recoveries afterward, is coming to UCHealth University of Colorado Hospital.<\/p>\n

\"Touchstones
Some Enhanced Recovery After Surgery touchstones, courtesy of the American Association of Nurse Anesthetists.<\/figcaption><\/figure>\n

ERAS, as it\u2019s known, has European roots and an impressive track record. A recent review of ERAS programs in more than 20 countries found them to shorten hospital stays by an astonishing 30 to 50 percent, with similar reductions in complications \u2013 in addition to reducing hospital readmissions and costs. Among other benefits for patients, ERAS means less thirst and hunger before surgery, less anesthetic and fewer opiate-based painkillers to slow them down after surgery, and more ease in getting out of bed, back home, and on the road to recovery sooner.<\/p>\n

Given this rainbow of benefits and the fact that ERAS has been around for about 20 years, the obvious question: what\u2019s been the holdup? History and habit, it turns out. As a group of physician scholars put it<\/a> in 2011, \u201cDespite the significant body of evidence indicating that ERAS protocols lead to improved outcomes, they challenge traditional surgical doctrine, and as a result their implementation has been slow.\u201d<\/p>\n

So six years hence, very few U.S. hospitals are doing ERAS. That\u2019s changing at UCHealth, thanks to the work of a UCH team led by Christine Woodman, BSN, MSA, and Katie Conyers, NP. After more than a year of laying the groundwork, they\u2019re poised to launch ERAS at UCH this April with pancreatic cancer surgery patients, with the aim of rolling it out for all inpatient surgeries going forward.<\/p>\n

\"Katie
Katie Conyers, NP, and Christine Woodman, RN, were the driving force behind University of Colorado Hospital’s new Enhanced Recovery After Surgery Program.<\/figcaption><\/figure>\n

Let\u2019s talk<\/strong><\/p>\n

Woodman is the nurse manager of the hospital\u2019s Pre-Procedure Services<\/a>, which gets people ready one to two weeks before their surgery. Conyers is a nurse practitioner in the unit and does medical assessments and planning for the more complex patients undergoing surgery. More than a year ago, they and others started working on ERAS as a project with the Institute for Healthcare Quality, Safety and Efficiency (IHQSE). The IHQSE is a collaborative effort <\/a>between University of Colorado Hospital, Children\u2019s Hospital Colorado and the CU School of Medicine and College of Nursing that gives health care providers hands-on training in leading comprehensive process improvement projects and delivering safe, high-quality care efficiently.<\/p>\n

\"This
Dr. Steven Zeichner<\/figcaption><\/figure>\n

\u201cWe became interested in this because it was a more comprehensive program for patients as they go through their surgical experiences and connect with all of the departments involved \u2013 from the time they make the decision to have surgery to the time they go home and beyond,\u201d Woodman said.<\/p>\n

Faculty from the CU School of Medicine\u2019s Department of Anesthesiology have played important roles, Woodman said. Steven Zeichner, MD<\/a>, worked to develop protocols and has been a consistent presence in developing the program; Tamas Seres, MD<\/a>, who has helped ERAS move forward, too, she added.<\/p>\n

\"This
Dr. Barish Edil, surgical oncology chief and the pancreatic surgery lead at University of Colorado Hospital.<\/figcaption><\/figure>\n

Pancreatic cancer surgery patients will be the first to roll into ERAS. Woodman, Conyers and colleagues chose this cohort for a couple of reasons. First, UCH\u2019s pancreatic cancer patients are already part of a streamlined multidisciplinary clinic<\/a> that brings diverse providers to the table quickly and efficiently. Second, Barish Edil, MD, the surgical oncology chief and the pancreatic surgery lead at UCH (he is among the few surgeons in the world capable of doing highly complex Whipple procedures laparoscopically<\/a>), was enthusiastic about ERAS from the moment they brought it up. With ERAS, those involved in patient care before, during and after surgery integrate more tightly as a team, he said.<\/p>\n

\u201cWe talk about what we think is best for our patients, and that communication leads to a standardized way of caring for them that\u2019s evidence-based \u2013 not based on dogma,\u201d Edil said.<\/p>\n

That same communication will pay dividends once ERAS rolls out, he added.<\/p>\n

\u201cIt will allow us to step back and see what works and doesn\u2019t work, and allow us to improve and optimize,\u201d he said. \u201cUltimately, I think it\u2019s going to lead to better outcomes and health care cost savings.\u201d<\/p>\n

Eat, drink\u2026<\/strong><\/p>\n

That\u2019s all behind the scenes. Patients will notice some big differences, though. For example, the UCH standard now is to have patients stop eating solid food at least eight hours before surgery and drink nothing in the four hours beforehand. With ERAS, the prevailing standard is to let patients eat until six hours before the procedure, and then give them an eight-ounce clear-liquid carbohydrate drink immediately before surgery. That\u2019s because patients do better with the extra hydration and blood sugar, research has shown. Of course, given that pancreatic cancer surgery focuses on the digestive tract, Edil and colleagues will be conservative in their adoption of this particular part of ERAS, Woodman said. But as the approach becomes established, she anticipates the approach will become a mainstay at UCH and across UCHealth.<\/p>\n

Intravenous fluid volumes will be standardized during surgeries, which will help avoid problems with wound healing that too much hydration can cause \u2013 as well as cardiovascular issues that too little hydration can bring, Woodman said. They\u2019ll have patients drink fluids just after surgery, and will reintroduce food earlier, too \u2013 as soon as the day of surgery, as compared to the two or three days abdominal surgery patients typically wait now. That will help kick-start the digestive tract, Woodman said.<\/p>\n

While making sure patients feel minimal pain, ERAS involves big changes in anesthetic approaches and pain management. One will be to minimize the use of opioids painkillers after surgery. Opioids can cause nausea and slow down the gut \u2013 the opposite of what pancreatic cancer patients need after surgery. Epidural-type pain blocks and non-narcotic pain relievers such as tramadol will be in the mix, Woodman said. Just as importantly, less-woozy patients can get up and move sooner, which brings faster recovery, Conyers added.<\/p>\n

\u201cWe want the patient to be as comfortable as they can be, so they can get up and walk on the first evening of surgery,\u201d she said.<\/p>\n

Another big piece of ERAS at UCH will involve patient and family education and \u201cprehabilitation.\u201d The education piece will encompass new, thorough multimedia tutorials, checklists and narratives about what to expect before, during and after surgery. Prehabilitation involves working with patients in a variety of ways, such as making sure things like lab samples and electrocardiograms have been done well in advance. Prehabilitation can also include such things as referrals to smoking-cessation, exercise and weight loss programs, and diabetes-management programs, which can help make patients more resilient during surgery and speed healing and recovery, Woodman said.<\/p>\n

There\u2019s much more to ERAS, and as the program becomes the standard across UCH \u2013 and, eventually, all UCHealth hospitals \u2013 more refinements lay ahead. One thing is certain, though, Woodman said.<\/p>\n

\u201cBy challenging some of our longstanding beliefs on how to care for surgical patients, it\u2019s changing the way we\u2019re doing surgical care,\u201d she said.<\/p>\n","protected":false},"excerpt":{"rendered":"

Enhanced Recovery After Surgery, designed to better prepare patients for surgery and speed their recoveries afterward, is coming to UCHealth University of Colorado Hospital. ERAS, as it\u2019s known, has European roots and an impressive track record. A recent review of ERAS programs in more than 20 countries found them to shorten hospital stays by an […]<\/p>\n","protected":false},"author":23,"featured_media":10092,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,415,4852],"class_list":["post-10091","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-pancreatic-cancer","tag-preparing-for-surgery"],"acf":[],"yoast_head":"\nSurgery prep, recovery poised for revolution - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Enhanced Recovery After Surgery, designed to better prepare patients for surgery and speed their recoveries afterward, is coming to UCHealth University of Colorado Hospital. 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