how everything you know about surgical protocol may change ii

Last time, we discussed how the American College of Surgeons is now urging more surgical teams to consider adopting what is known as “enhanced surgery” protocols, which are essentially a complete overhaul of the traditional preparation and recovery practices for surgery.

In general, most people undergoing surgery will be required to abstain from food and most beverages prior to their procedure, and will be administered a large dose of IV fluids during the actual procedure. Afterward, doctor’s orders will call for painkillers to help manage post-op pain and considerable bed rest.

As time-tested as these preparation and recovery practices for surgical patients may be, some critics say they are not without their drawbacks.

For instance, they argue that the need to fast prior to surgery can amplify feelings of anxiety, while the nutrient deficiency that accompanies it can result in post-op nausea. Furthermore, they argue that the large doses of IV fluids, a heavy regimen of painkillers and emphasis on bed rest can actually interfere with the resumption of normal bodily functions and impede overall recovery.

Indeed, a study from the Duke University School of Medicine determined that these traditional preparation and recovery practices can result in surgical patients staying in the hospital for 10-plus days with increased complication rates (up to 48 percent) and additional costs (up to $10,000).

Under the aforementioned enhanced recovery protocol, conceived in Europe 15 years ago, people undergoing surgery will also be expected to fast, however, they will also be given a clear liquid drink fortified with various vitamins, minerals and electrolytes before going under the knife. Lower doses of IV fluids are then used during the surgery, while non-narcotic painkillers are administered beforehand. After surgery, patients are encouraged to get out of bed, eat solid foods and be discharged as soon as possible.

Proponents of the enhanced recovery protocol point to a recent study by none other than the American College of Surgeons, which found that colorectal surgical patients who were treated under this approach saw their hospital stays reduced by 2.2 days versus a control group treated using the traditional preparation and recovery practices. These patients also saw a lower complication rate (17 percent), increased satisfaction with pain control (55 percent) and significant savings ($7,129 per patient).

It remains to be seen whether we will see widespread adoption of the enhanced recovery protocol and whether it is truly as safe as these experts are saying.

Source: The Wall Street Journal, “Patients bounce back faster from surgery with hospitals’ new protocol,” Laura Landro, March 31, 2015

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