With ERAS, Christopher Wu and Elizabeth Wick hope to decrease hospital stays and improve patients’ experiences.
If I were to need major bowel surgery,” says anesthesiologist Christopher Wu
, “I would want treatment that avoids narcotics and anesthetic gasses, as well as manages fluid tightly.” But that is not the entirety of Wu’s colorectal surgery wish list.
“I would want every piece of evidence I could to have my best outcome,” he says, “and with the new enhanced recovery after surgery (ERAS) pathway being used at The Johns Hopkins Hospital, I think we’re doing that.”
In early 2014, a Johns Hopkins team of nurses, surgeons and anesthesiologists started incorporating ERAS for colorectal surgery. It encompasses the preoperative, intraoperative, postoperative and post-discharge phases of care, as well as a standard perioperative anesthetic plan.
Length of stay significantly improved
Surgeon Elizabeth Wick says ERAS changes the paradigm of how patients are treated. Typically, a patient stays in the hospital between five and 10 days after colorectal surgery. A recent meta-analysis of 13 studies, however, found that ERAS decreased length of stay by 50 to 60 percent.
Now at Johns Hopkins, nurses work closely with patients before surgery to provide print and electronic educational materials, supplies for surgery preparation, checklists and instructions. “It engages the patient much more in their care,” says Wick.
Then, during surgery, to avoid anesthetic gasses, intravenous fluids, and postoperative nausea and vomiting, “We are trying to use modalities like epidural anesthesia and propofol infusion,” says Wu. “And when patients are ready for oral medications, we use nonopioid agents, like NSAIDs, as well as other nonnarcotic painkillers.”
Postoperatively, nurses encourage patients to drink the proper amount of fluids, to get out of bed more quickly, to get moving and to eat, explains nurse clinician Deb Hobson.
After just a few weeks, the results are encouraging: Length of stay has decreased by two days compared to the previous six months’ average, and patients seem to feel better. “Their pain is under better control,” says Wu. “They are eating sooner and are ready to go home.”
If clinical data show that ERAS is successful for colorectal surgery over time, the same techniques could be applied for other surgical procedures in the abdomen. “While the pathway regimen would differ, the concept is very similar,” says Wu. “A program like this takes a team of champions across disciplines who work well together and have good communication.”
“If I were to have this type of surgery,” says Wu, “this is exactly what I would want.”
To refer a patient: 443-997-1508