Twenty years ago, having knee or hip replacement surgery meant a two-week hospital stay.
That’s changed drastically.
“Here at Novant Health, patients typically stay one night before they return home,” said Dr. James Fraser, an orthopedic surgeon at Novant Health Barron, Homesley & Valentine Orthopedic Specialists - Charlotte. “Some patients are even successfully discharged to go home on the same day as surgery.”
A key reason for that change is Enhanced Recovery After Surgery (ERAS), a treatment program at Novant Health that has replaced many traditional practices with an evidence-based approach.
The goals for ERAS: shorten recovery time and hospital stays, decrease the patient’s risk of complications and improve patient satisfaction after major surgery.
“Historically, a lot of the complications we experienced with major joint surgeries related to prescribed bed rest after surgery,” Fraser said.
But as it turns out, “The more time patients spend lying in hospital beds, their risk of developing blood clots and acquiring infections increases.”
Novant Health’s ERAS protocol for joint replacement surgeries encourages patients to walk the same day as their procedure.
ERAS success begins long before a patient’s surgery.
“We follow a comprehensive protocol, and it takes effect the first time a surgeon sees a patient,” said Dr. Douglas Rosen, a Novant Health colon and rectal surgeon. “The most important aspect of the first visit is to educate the patient about the surgical procedure and their expectations surrounding surgery.”
Patients can help their recovery time by optimizing their health before surgery. That usually involves improving nutrition, increasing physical activity and taking a break from (or quitting) smoking. Smoking slows healing because it slows blood flow.
Patients are also told how long they should expect to be in the hospital and the importance of walking as soon as possible after surgery. Those details are reinforced during a pre-surgical hospital visit and again on the day of surgery.
“We work against generations of surgical dogma that says patients should be in bed on a morphine drip and not eating after surgery,” said Dr. Rob Stevens, a Novant Health colon and rectal surgeon. “We learned that approach did a lot of harm. Our ERAS program focuses on re-educating patients about what to expect.”
Management and medication
When patients arrive on the day of surgery, multiple specialists work together to ensure their best chances for successful surgery.
“In the past, patients were told not to eat or drink anything before surgery,” said Dr. David Sindram, a Novant Health hepatobiliary surgeon. “Now, we make sure the patient enters surgery well hydrated.”
Before surgery, patients also drink a beverage high in carbohydrates, similar to a meal replacement shake. This helps keep the patient’s glucose levels stable during the procedure and promotes healing.
Pain management is another important aspect of the ERAS program. Novant Health works with community anesthesiology practices, such as Providence Anesthesiology Associates and Piedmont Triad Anesthesia to reduce the use of opioids during and after surgery.
Early adoption of ERAS protocols has allowed Novant Health to develop a program that covers seven types of surgical procedures - colorectal, bariatric, gynecologic, gynecologic oncologic, orthopedic, prostatectomy and pancreaticoduodenectomy (otherwise known as Whipple procedures).
“ERAS protocols have a tremendous impact on a patient’s well-being,” Sindram said.
“We’ve reduced opioid use for colorectal and Whipple patients by 65 to 70 percent.”