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:6/27/2016)... ... June 27, 2016 , ... A revolution ... the emergency ambulance transport experience for the millions of people who require these ... disrupted the taxi industry through the use of technology. Now, SmartEMS has put ...
(Date:6/26/2016)... North Carolina (PRWEB) , ... June 26, 2016 , ... ... release of a new product that was developed to enhance the health of felines. ... for centuries. , The two main herbs in the PawPaws Cat Kidney Support ...
(Date:6/25/2016)... ... June 25, 2016 , ... The temporary closing of Bruton Memorial Library on June 21 due ... up a new, often overlooked aspect of head lice: the parasite’s ability to live away ... a common occurrence, but a necessary one in the event that lice have simply gotten ...
(Date:6/25/2016)... ... , ... On Friday, June 10, Van Mitchell, Secretary of the Maryland Department ... in recognition of their exemplary accomplishments in worksite health promotion. , The Wellness at ... Wellness Symposium at the BWI Marriott in Linthicum Heights. iHire was one of 42 ...
(Date:6/24/2016)... ... , ... Marcy was in a crisis. Her son James, eight, was out of control. Prone ... physically. , “When something upset him, he couldn’t control his emotions,” remembers Marcy. “If ... at my other children and say he was going to kill them. If we ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... FRANCISCO, Calif. , June 24, 2016 /PRNewswire/ ... ), a biopharmaceutical company developing novel therapeutics for ... unmet needs, today announced the closing of its ... of common stock, at the public offering price ... in the offering were offered by GBT. GBT ...
(Date:6/24/2016)... Dublin - ... " Global Markets for Spectroscopy Equipment" report ... This report focuses on the global market of ... applications in various applications. The report deals with spectroscopy ... industries: pharmaceutical and biotechnology, food and beverage, and environmental ...
(Date:6/24/2016)... , June 24, 2016 The Academy of ... recommendations that would allow biopharmaceutical companies to ... entities that make formulary and coverage decisions, a move ... of new medicines. The recommendations address restrictions ... appear on the drug label, a prohibition that hinders ...
Breaking Medicine Technology: