Surgery just got a whole lot easier

ERAS program can cut hospital stay in half

The thought of missing work troubled Bettie Hart. To the reading recovery teacher at Overdale Elementary in Hillview, Kentucky, Hart’s students mean the world to her.

“I really love my job, these kids,” Hart, age 64, said. “They struggle with reading, and I want to help them in every way I can.”

So when doctors found a mass in Hart’s colon, she was especially troubled. The average hospital stay for that type of surgery was 10 days. It would be up to eight weeks before Hart could return to work.

“The first thing I thought of was ‘how can I miss work?’” she said. “I wanted to wait until Christmas break, but the doctors said we couldn’t hold out that long.”

That’s when doctors at Norton Audubon Hospital mentioned a new program for surgery patients designed to get them home and back to their routine faster: Enhanced Recovery After Surgery, or ERAS.

“ERAS involves a series of steps before, during and after surgery designed to manage pain and get the patient’s body functioning normally again,” said William Bradford, M.D., medical director, Norton Audubon Hospital. “We thought Bettie would be a great candidate for it.”

Early results from Norton Audubon’s ERAS program are potentially game changing. Patients who’ve used ERAS cut their average hospital stay in half — saving time and money — and overall recovery for colon patients improved from eight weeks to four. Complications and trips to the intensive care unit also were lower among this group.

How does ERAS work? Traditionally, surgical patients are not allowed to eat or drink anything before surgery. Some patients had to use a bowel preparation and then recover after surgery with a tube and urinary catheter. This method, along with using only narcotics for pain control, slowed bowel function and decreased the body’s ability to deal with the stress of surgery.

With ERAS, bowel preps are needed less often, and time with a urinary catheter is decreased. It also includes new options for pain control and fewer narcotics, decreasing side effects such as drowsiness, anxiety, dizziness, nausea and constipation.

“Basically, ERAS techniques help prepare the body for surgery and create less stress during and after the procedure,” said Patrick Shanahan, M.D., anaesthesiologist, Norton Healthcare. “Bringing all these components together results in faster recovery for the patient.”

ERAS, which has been used in Europe for decades but is relatively new to the U.S., does require the patient to be more involved in his or her own care. They must drink a variety of liquids in the days and hours leading up to surgery, as well as immediately after waking up. Patients also must eat food and get up out of bed within a few hours of the procedure.

ERAS has been so successful, the program has been expanded to Norton Hospital, Norton Brownsboro Hospital and Norton Women & Children’s Hospital. The program also is being incorporated into other types of surgery, including neurology, orthopaedics and, potentially, heart procedures.

“I really feel this will be a standard of care for all patients in the near future,” Dr. Shanahan said.

For Hart, ERAS was certainly the way to go.

“Three days after surgery I left the hospital. I had minimal pain when I got home — ibuprofen took care of it,” she said. “I went back to work after four weeks although I feel like I could’ve returned sooner.”

And that created lots of smiles at Overdale Elementary.

Want to see if you’re a candidate for ERAS? Check out this video.


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