According to new research presented at the American Society of Anesthesiologists PRACTICE MANAGEMENT meeting, colorectal and bariatric surgery patients benefited from an enhanced recovery after surgery (ERAS) program, leaving the hospital sooner and requiring fewer opioids to control pain.
ERAS programs use a variety of methods to ease the effects of surgery and facilitate early patient recovery. They are an important aspect of the Perioperative Surgical Home (PSH), in which a patient's surgical experience is fully coordinated and treated as a continuum of care. Providence Anesthesiology Associates in Charlotte, North Carolina compared the results of 621 patients undergoing colorectal or bariatric surgery who participated in an ERAS program to historical data prior to the implementation of the ERAS.
Colorectal patients in the ERAS group stayed in the hospital 2.05 days compared to 4.5 days for non-ERAS patients. Bariatric patients in the ERAS group stayed .95 days vs. 2.15 for non-ERAS patients. Patients in both ERAS groups used significantly fewer opioids after surgery than those in the non-ERAS groups and had shorter stays in the post-anaesthesia care unit (PACU). Pre-surgical consultation with pain medicine specialist eases anxiety for certain patients. The study includes 12 spinal fusion patients who consulted with a physician anesthesiologist pain specialist before surgery.
Each patient met with the physician anesthesiologist, who consulted with the surgeon and patient to formulate a plan for the most appropriate pain management after surgery. That plan was shared with the patient's primary care or pain medicine specialist. The patients reported they were less stressed about surgery, less anxious during the perioperative period and more satisfied with pain control after surgery. The researchers believe the method may help decrease hospital length of stay which could lower costs, as well as improve patient satisfaction.
Assessing patients for frailty before surgery could prevent bad outcomes. The researchers suggest using a short questionnaire to screen for frailty, such as Fried's Frailty criteria since frailty can be an independent predictor of postoperative complications. Patients who are identified as frail prior to surgery should be optimized before undergoing the procedure through nutrition, strength training, improving balance and mobility, counselling and medications, the researchers note. A frailty assessment before surgery can help providers determine whether a patient is strong enough for surgery and if not, help determine if the patient's health can be optimized to enable the procedure.
In conclusion, the research team highlights how physician anesthesiologists are leading the way in improving the entire surgical experience for patients – from the decision to have surgery through discharge, recovery and beyond – to help enhance outcomes and reduce costs.