Why Wait? Enhanced Recovery Programs Can Help You Bounce Back from Colorectal Surgery Faster
Dr. Carlos Glanville is one of several colorectal surgeons working on a pilot program to help surgical patients with enhanced recovery programs. Many people don’t consider that there might be multiple ways of getting through the process of preparing for surgery, having surgery and then recovering from surgery.
While Dr. Glanville was completing his colorectal surgical fellowship at the Colon and Rectal Clinic of Orlando, he learned about the enhanced recovery programs. Today, he works as a surgeon at Sentara Surgery Specialist in Suffolk, Virginia. The pilot program is currently only for colorectal surgery and involves pre-admission counseling so the patient knows what to expect.
“The program needs to have patients who buy in to doing things a bit differently. There’s a nurse educator who helps with the process,” said Dr. Glanville.
In some cases, it might be something additional: drinking carbohydrate fluids the night before surgery, or taking antibiotics or pain medication before surgery. But it may also be something you don’t do or do less of. For example, instead of fasting from midnight until the time of surgery the next day, there’s an alternative with a shorter window of fasting.
“These are evidence-based pathways that use nationally recognized care guidelines to improve clinical outcomes and minimize trauma from surgery. That means that pain is reduced after surgery and complications are less likely,” said Dr. Glanville. “It’s not a new concept. But we are seeing good results from a set of protocols that happen before, during and after surgery.”
One of the notable parts is avoiding narcotics, and using other pain relief methods instead, including a spinal block for pain control or short-term anesthetic. Many other types of surgery have shifted to a philosophy of “get up and get moving” and this is part of the enhanced recovery process as well. The patient walks several times a day, getting out of the hospital bed and moving – slowly, of course, but it’s important for the patient to be upright and start to move.
“It’s a more interactive process, so the patient has to agree to be more active. They can’t lay in bed and rest…there’s a push to get up walking, eating, and off the IV. The evidence seems to say that if you treat them like a healthy person, it gets them home faster and in better shape,” said Dr. Glanville.
In colorectal surgery, it’s important to get the digestive system working again after the disruption of surgery, and so patients are encouraged to eat, drink and chew gum to get the system primed to return to normal.
“Patients after a big colorectal surgery used to have a tube in their nose, not be able to eat and would have to wait to pass gas or have bowel movements. The new protocols decrease the incidence of bloating, slow bowels, nausea and vomiting. This is especially important in elderly patients who then have less chance of getting weak or being discharged to a nursing facility if they can get back to baseline sooner,” said Dr. Glanville.
This stepped approach seems to have positive results and the pilot program may be expanded to other types of surgery in the future. Dr. Glanville is excited about this program.
“Patients who will do great after surgery, will still have great outcomes, and people who might have done fine before, now have the chance to do great. We are essentially maximizing the number of people who do well!”