New approach to managing surgery will speed patient recovery but challenges current practices
A review in CMAJ challenges historical surgical practices that are not research-based, outlining a multidisciplinary approach called enhanced recovery after surgery (ERAS) that will help patients recover more quickly from surgery. The article, published in CMAJ (Canadian Medical Association Journal), reviews the evidence supporting the approach and how it could be implemented in Canada.
Enhanced recovery after surgery is an evidence-based treatment program created to improve patient outcomes with faster recovery. It takes a holistic approach by involving family doctors, nurses, surgeons, anesthesiologists, nutritionists and other health care professionals before surgery right through recovery, with the goal of helping patients get back to normal functioning as soon as possible.
"ERAS involves changing the way we, as a medical community, think about preoperative, intraoperative and postoperative care to improve all surgical outcomes," says lead author Dr. Alon Altman, gynecologic oncologist and associate professor, University of Manitoba, and program director, Obstetrics & Gynecology, Winnipeg Health Sciences Centre, Winnipeg, Manitoba.
It has been shown to promote patient movement after surgery, reduce complications and reduce hospital length of stay as well as costs, and is currently being used in some Canadian hospitals and others around the world, including in the United States and the United Kingdom.
Enhanced recovery after surgery can be broken down into three stages: preoperative, intraoperative (during surgery) and postoperative. It involves changes such as modifying diet before surgery, stopping certain medications, changing some procedures during surgery, getting patients moving within 24 hours after surgery and more.
"This approach should be used for all surgical patients, as the intent is to lessen stress on the patient and maintain normal functioning," says Dr. Altman.
There is increased interest in Canada to adopt this approach, although there are challenges because of the many different health care professionals who need to be involved.
"Despite the challenges of implementing ERAS, there are clear advantages for patients and the health system, such as a healthier recovery using fewer resources," says coauthor Dr. Gregg Nelson, chief of gynecologic oncology, Tom Baker Cancer Centre, Calgary, Alberta, and surgical lead of ERAS Alberta. "A team approach, from involving family physicians before patients undergo surgery to surgeons and postrecovery staff in hospital, is a key part of successful implementation."
More information: Canadian Medical Association Journal (2019). www.cmaj.ca/lookup/doi/10.1503/cmaj.180635