Hospitals are starting to abandon the time-honored drill for surgery patients— including fasting, heavy IV fluids, powerful post-op narcotics and bed rest— amid growing evidence that the lack of nutrients, fluid overload and drug side effects can do more harm than good.
Instead, they are turning to “enhanced recovery” protocols that are easier on patients, help them get better faster with fewer infections and other complications and reduce health-care costs.
The changes, pioneered in Europe over the past 15 years, now are being adopted more widely in the U.S. Though the evidence is strongest in colorectal surgery, the approach is being used with an increasing range of procedures including hip fracture and joint replacements and surgeries for bladder, pancreas, liver and breast cancer.
Hunger and thirst from presurgical fasting can add to patients’ stress and anxiety, and cause weakness as well as postoperative nausea. Side effects of fluid retention, narcotics and immobility can interfere with getting bodily functions back to normal, resulting in longer, harder recoveries overall. With traditional regimens, patients can remain in the hospital for 10 days or more with complication rates of up to 48% and an average $10,000 in additional costs, according to researchers at Duke University School of Medicine.
With enhanced recovery protocols, patients still can’t eat after midnight before an early morning surgery, but two or three hours before surgery they do get a carbohydrate-loaded drink fortified with electrolytes, minerals and vitamins. They are pretreated for pain with nonnarcotic painkillers and epidurals that are kept in place postoperatively. With careful monitoring, patients receive only necessary levels of IV fluid during surgery. Soon afterward they get out of bed to walk and may ingest solid food, and they are discharged earlier with careful instructions for home care.
“This is contradictory to the way we’ve practiced for 50 years, but it is becoming more and more evident that this really is more effective and better for patients,” says Traci Hedrick, assistant professor of surgery at the University of Virginia. “Surgery is already a significant trauma on the body and we want to help keep patients as normal as possible for as long as possible.”