Navigation Links
New approach for surgery patients cuts hospital stays and costs
Date:4/24/2014

DURHAM, N.C. Changes in managing patients before, during and after colorectal surgery cut hospital stays by two days and reduced readmission rates, according to researchers who led a study of the approach at Duke University Hospital.

The practice, called enhanced recovery, is easier on patients before surgery, doing away with the fasting period and bowel evacuation that are typically prescribed. After surgery, patients are encouraged to eat and move about as soon as possible, leading to faster recoveries.

Among findings published in the May 2014 issue of the journal Anesthesia & Analgesia, the researchers reported that the enhanced recovery approach used for colorectal surgery cut hospital admissions from an average seven days to five, and reduced the rate of readmissions by half.

"Enhanced recovery is about change management," said senior author Tong J. Gan, M.D., MHS, professor of anesthesiology at Duke. "It's getting the team together, including nurses, anesthesiologists, surgeons and patients, with everyone understanding the expectations of how to do things differently and improve patient care."

Gan and colleagues collected data from 241 consecutive patients at Duke University Hospital undergoing open or laparoscopic colorectal surgery during two time periods: before the enhanced recovery approach was implemented, and after. Ninety-nine patients were studied in the traditional approach, and 142 using enhanced recovery.

With traditional perioperative care defined as the care provided through a patient's hospitalization for surgery few procedures are standardized, but patients are typically told to fast the night before and undergo laxative treatments, and then are not given food or drink after surgery until bowel sounds are restored, sometimes several days later. Additionally, traditional perioperative care includes a variety of different anesthesia regimens, fluid management and pain control, depending on the surgical team's preferences.

Under traditional perioperative care, patients who experience pain, stress, immobilization, and postoperative constipation can remain in the hospital for 10 days or more, with complication rates of up to 48 percent. Such complications can be expensive, estimated at an average of $10,000.

Enhanced recovery after surgery (ERAS), which has gained favor in Europe but has not been widely used in the United States, aims to standardize perioperative care using procedures backed by scientific evidence that demonstrate their benefits.

In the Duke study, patients in the ERAS group were educated about what they should expect. Routine bowel preparation was not performed, and patients were allowed to drink clear fluids until 3 hours before their surgeries, notably a sports drink.

All of the ERAS patients received an epidural as well as non-opioid painkillers to reduce opioid side effects such as nausea, vomiting, constipation, urinary retention and drowsiness. They then underwent general anesthesia. After surgery, the patients transitioned to oral acetaminophen or other non-steroidal anti-inflammatory drugs, plus oral opioids, if necessary, after about 72 hours. Patients were also encouraged to drink liquids and get out of bed on the day of surgery, and for at least six hours every subsequent day.

"We have shown that providing care within an ERAS pathway, we are increasing the quality of care for patients while at the same time reducing complications and medical costs," said co-author Timothy Miller, assistant professor of anesthesiology at Duke. "I believe that going forward, enhanced recovery care could become the new standard for best practice."

Gan said the researchers saved costs for about 85 percent of the ERAS patients, at about $2,000 per patient. He said the ERAS approach could be used for numerous surgeries; it has been expanded at Duke University Hospital to include bladder, pancreas and liver surgeries.

"Our study demonstrates that the patient-focused enhanced recovery approach uses evidence-based concepts to decrease perioperative stress and improve outcomes from surgery," said lead colorectal surgeon and co-author, Julie K. Marosky Thacker, M.D.


'/>"/>

Contact: Sarah Avery
sarah.avery@duke.edu
919-660-1306
Duke University Medical Center
Source:Eurekalert

Related medicine news :

1. Depressed? Researchers identify new anti-depressant mechanisms, therapeutic approaches
2. New approach may help manage the most troubling symptoms of dementia, lessen use of drugs
3. Benaroya Research Institute evaluates immunology approach to blocking breast cancer
4. Dartmouth researchers develop new approach to chronic lymphocytic leukemia treatment
5. New guidelines employ a team approach to autism diagnosis and care
6. New approach to prostate cancer screening needed
7. REACT clinical trial supports new approach of accelerated treatment for Crohns disease
8. Researchers find novel approach for controlling deadly C. difficile infections
9. Novel biomarker approach suggests new avenues to improve schizophrenia disease management
10. Craig Stephens as a Marketing Specialist for Plastic Surgeons Offers a Decidedly Unique Approach to Surgeons for Developing Their Online Presence
11. OHSU researchers develop new drug approach that could lead to cures for wide range of diseases
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... ... February 12, 2016 , ... Fisher House Foundation Chairman and ... J. Lee, Nevada Military Support Alliance president Scott Bensing, and Peggy Kearns Director, VA ... Southern Nevada Healthcare System. This will be the first Fisher House in Nevada, ...
(Date:2/12/2016)... ... ... Vail knee specialist Robert LaPrade, MD, PhD was named one of ... of physicians establishing, leading and partnering with ambulatory surgery centers across the United States. ... also known as an ASC, is a modern health care facility focused on providing ...
(Date:2/12/2016)... ... February 12, 2016 , ... Donor Network West, the organ procurement organization that ... partnership with San Ramon Regional Medical Center. Under the collaboration, the first of its ... to accommodate a more certain time frame for donor families for the recovery of ...
(Date:2/12/2016)... Land, TX (PRWEB) , ... February 12, 2016 ... ... families of southwest Houston and surrounding communities by continuing it’s commitment to act ... Bend Family Promise. The organization works closely with area homeless families to fulfill ...
(Date:2/12/2016)... (PRWEB) , ... February 12, 2016 , ... ... High-Cost Drug Categories: Strategies for Health Plans and PBMs,” an upcoming Feb. 24 ... maintain affordability and access in big-dollar therapeutic categories, such as the $1,000-per-pill hepatitis ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... -- - Cardiac Marker Diagnostic Testing ... Cancer Therapy. - European Point of Care Diagnostic ... - Key Diagnostic Testing Markets. - Molecular Diagnostics ... Testing. - Molecular Diagnostics in Infectious Disease Testing. ... Products World Markets. - Point of Care Diagnostic ...
(Date:2/11/2016)... 2016 Laboratory glassware and plasticware ... These may range from microscope slides to large storage ... from borosilicate glass because of its low weight and ... hand, started gaining popularity over the past decade when ... glass with plastic in several applications due to its ...
(Date:2/11/2016)... 11, 2016   Health 2.0 , the premiere ... technologies, announced today " 10 Year Global Retrospective ", ... over the past ten years.   ... Health 2.0 has served as the preeminent thought-leader in ... thousands of technologies, companies, innovators, and patient-activists through an ...
Breaking Medicine Technology: