Enhanced Recovery Protocol for Colon Surgery

What is the enhanced recovery protocol for colon surgery?

This is a new program that we've started at Memorial Hospital. Enhanced recovery after surgery is a program that was started over in Europe and has come over to the United States and is gaining quite a bit of momentum. It is a multi-modal program that looks at the entire perioperative phase. From when the patient starts in the office to when they're completely recovered, it looks at and addresses all those factors to help the patient through the process.

What type of surgeries does this protocol cover?

It's really any colon surgery. The most common things that we treat are diverticulitis, colon cancer, or some sort of colon polyps.

What are the benefits of this protocol?

Some of the benefits are shorter length of hospital stay, less complications, and higher patient satisfaction. It takes evidence-based medicine and applies it to the things we've been doing for years and years.

How does the enhanced recovery protocol work?

Right now, it just applies to colon and rectal surgery, and we've broken it down into three phases: preoperative phase, intraoperative, and postoperative.

Preoperative Phase

There are several important things there. Some of the big changes now are letting patients drink liquids up until a couple hours before surgery, where it used to be nothing after midnight. We're giving them carbohydrate drinks ahead of time, which has been shown to decrease nausea, vomiting, and the stress of surgery. We're really focusing on patient education. We've created a patient education booklet that we start with in the office and explain to the patients what this program is about. It really goes through the different phases with the patient as far as what's going to happen before surgery, right after surgery, and during the recovery period. We also are focusing more on smoking and alcohol cessation. If the patients need some preoperative physical therapy, we'll do that as well.

Intraoperative Phase

We're really trying to focus more on doing minimally invasive surgery and using less narcotics during the surgery. Anesthesia is working with us to direct the fluid replacement based on specific parameters. In the old days, we just dump lots of fluids into the patient, and now we're really focusing on what the patient needs. We've found that that helps with the recovery as well.

Postoperative Phase

Some of the big things include early ambulation (walking around), so we we are getting these patients out of bed almost as soon as they get to the floor. If their surgery's done by two o'clock, they're going to be out of bed twice that day. We're starting on a diet sooner so a lot of these patients are starting with clear liquids when they get out of the recovery room to their floors. We're really focusing on a patient care plan, and they've created care maps so the patients can really understand what's going to happen on day one, day two, day three, until they go home. And then we follow up in the office. So it really looks at the entire process from the beginning to the end. The studies out there show that is quite a benefit to the patients.

Which providers or specialties are involved in making this protocol a success?

This involves a lot of different specialties. From a physician standpoint, anesthesiologists, primary care physicians, and hospitalists are involved. Pharmacy has also been very involved with this. Obviously, nursing has played a huge role as well as physical therapy and dietary.