More hospitals adopt 'enhanced recovery' protocols for surgical patients

Standard hospital protocols for surgery patients include heavy IV fluids, strong post-operative drugs, bedrest and fasting, but many providers have started to rethink this routine in the wake of growing evidence it can hinder the recovery process, according to the Wall Street Journal.

Research has found, for example, that pre-operative fasting often contributes to patient anxiety due to hunger and thirst, and can cause physical weakness and nausea. Fluid retention and the use of narcotics, meanwhile, can keep bodily functions from returning to normal, as research indicates the traditional process can extend stays 10 days or more and increase complication rates as much as 48 percent. This is a major concern in an era of readmission penalties, as a 2013 study found nearly 1 in 7 surgical patients is readmitted within 30 days.

Many providers instead have introduced "enhanced recovery" protocols, which have gained steam in Europe over the past 15 years and spread in the United States as well. Evidence of their effectiveness is strongest for colorectal surgery, but providers are also incorporate them into procedures such as joint replacements and several types of cancer surgery, according to the article.

Under enhanced recovery, patients must fast after midnight prior to early-morning procedures, but receive a drink fortified with minerals, vitamins and electrolytes a few hours prior to surgery as well as non-narcotic painkillers and epidurals. Patients may eat solid food shortly after they are well enough to get out of bed and walk. Under the protocols, patients are also discharged earlier with detailed home-care instructions.

"This is contradictory to the way we've practiced for 50 years, but it is becoming more and more evident that this really is more effective and better for patients," Traci Hedrick, assistant professor of surgery at the University of Virginia, told the WSJ. "Surgery is already a significant trauma on the body and we want to help keep patients as normal as possible for as long as possible."

Hospitals also have made progress with post-surgical pain, with a 2014 survey finding the proportion of patients who reported moderate to severe post-surgical pain dropped from 63 percent in 2003 to 39 percent, FierceHealthcare previously reported.

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