Hospitals are replacing traditional surgery preparation and recovery practices — fasting, heavy IV fluids, powerful post-op narcotics and bed rest — with enhanced recovery protocols:
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.
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Surgeons adopted the practice of infusing fluid, for example, after wartime studies showed it improved survival in trauma patients, but it isn’t necessary in the average patient, Dr. Thacker says. “Giving extra IV fluids to overcome the starvation we’ve imposed on patients leads to worse outcomes,” such as preventing bowel function from returning to normal, she says.
Rules on fasting before surgery are based on assumptions that anesthesia reactions might cause patients to throw up during a procedure and hamper breathing, but research has shown clear liquids within two hours actually decreases that risk, according to John Abenstein, president of the American Society of Anesthesiologists and a Mayo Clinic anesthesiologist. OR teams are sometimes reluctant to adopt the less-restrictive policies out of concern patients won’t follow directions and come in for surgery having had a glass of milk or cola, and then surgery has to be delayed, Dr. Abenstein says. But when patients consume clear liquids correctly, they feel much better after surgery, he says.