For decades, the pre-and post-surgery routine has been common for nearly all procedures: No eating before surgery; use pain medications for comfort; and stay in bed until recovery. These guidelines were considered the best ways to avoid complications.
After seeing substantial growth in hospital readmissions (Medicare paid $528 million in 2016 and more than $100 million in 2015) and an opioid epidemic spiraling out of control (2 million Americans with a substance abuse disorder with prescription medications), it is clear that physicians need to overhaul the post-surgery strategies currently in use.
Several centers have been developing the concept of “fast-track” or “enhanced” recovery after surgery. Recently, comprehensive research has indicated that an ERAS (“Enhanced Recovery After Surgery”) methodology that permits patients to eat before surgery, limits opioids by prescribing alternate medications, and encourages regular walking reduces complication rates and accelerates recovery after surgery. ERAS can reduce blood clots, nausea, infection, muscle atrophy, hospital stay and more. Patients are also given a post-operative nutrition plan to accelerate recovery, and physicians are using multi-modal analgesia, limiting the use of narcotics.
One particular program that has so far enlisted 9,000 surgical patients, reported a drop in surgical complications by one-third. The program also reduced its opioid prescriptions by 21%. The study, which was reported in the Journal of American Medical Association, demonstrated a decrease in mortality in colorectal resection patients. The study also showed a higher rate of hip-fracture patients being discharged to their homes, rather than skilled nursing facilities. Another study indicated ERAS protocols are reducing costs by more than $6,500 per patient.
“The results have been striking,” said Conor Delaney, MD, PhD, Chair of the Digestive Disease & Surgery Institute at Cleveland Clinic. “Employing ERAS, we’ve shown that patients going home within 2 or 3 days of surgery have extremely low readmission rates of 2%”
In 2017 collaborations were formed between surgical societies and large healthcare systems to drive funding and education for hospitals looking to implement ERAS protocols on a larger scale. The results and collaborations spell the end for the old playbook, and the dawn of a new era of surgical recovery.
Where Are They Now
Today there are entire societies dedicated to the concept of enhanced recovery after surgery. Symposiums are held every year to bring the medical field up to speed on best practices. Positive results of two small studies implementing ERAS programs were released recently, illustrating findings such as decreased length of stay and reduction in opioid consumption. Increased implementation of ERAS programs is expected in the wake of the opioid crisis.