MAHC-Community-Health-Bulletin-Final

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Study researches Enhanced
Recovery After Surgery
A
research study into reducing complications
after colon surgery and
maximizing early recovery is gaining
momentum and starting to show some
promising results locally.
For the past year, general surgeon Dr.
Hector Roldan has been leading a study
into Enhanced Recovery After Surgery
(ERAS), a concept that captured his interest
at an educational conference in Montreal.
“ERAS was initially developed in Europe
over a decade ago,” explains Dr. Roldan.
“The numbers they were reporting in their
results were really great and I wanted to
learn more about it.”
ERAS re-examines traditional practices
throughout the patient’s journey through
the surgical process – before, during and
after the operation. It uses alternative care
pathways that enhance recovery to help
minimize the hospital stay, while maintaining
patient safety and satisfaction.
“Everything we do is about patients and
there are always things that can be better,”
says Dr. Roldan. “Innovation is about moving
away from the norm and challenging the
status quo.”
Dr. Roldan prepared a proposal, secured
academic funding from the Northern
Ontario Academic Medical Association and
recruited a small research team including
anesthesiologist Dr. Andrew Brown,
Registered Nurse First Assistant Jane Radey
and research coordinator Snehal Wartharkar.
The success of the study also relies on
team support and the group has engaged
the surgical nursing team with education
about the program.
The goal, says Dr. Roldan, is to establish
an ERAS protocol locally for patients undergoing
colorectal surgery based on previously
standardized evidence-based enhanced
recovery programs.
The study delves into issues like surgical
complications that cause patients to return
to hospital, prolonged or delayed rehabilitation
after surgery because of pain and/or
complications, and operating techniques
during surgery that better support normal
bowel function after surgery.
“The average length of stay in hospital
after colorectal surgery is four or fi ve days,
Dr. Hector Roldan and Registered Nurse First Assistant
Jane Radey with the esophageal Doppler monitor.
although with complications it could be
as long as 10 days,” explains Dr. Roldan.
“Using ERAS, we’re studying the ability to
decrease the hospital stay to three days,
which we have already achieved in two
cases. This means the patient can go home
sooner and recover at home, which is best
for the patient.”
An investment was made in an esophageal
Doppler monitor, which is a probe that
gets information from the heart during
surgery. The Doppler helps to standardize
intravenous fl uid levels in the Operating
Room and measures how the heart
responds to the surgical procedure, which
guides the clinicians in the appropriate
amount of fl uid and drugs needed to administer
during surgery.
Good fl uid management helps to avoid issues
with postoperative ileus, which affects
many patients undergoing bowel resection
surgery and can cause signifi cant discomfort
and prolong the hospital stay, or cause
hospital readmission.
As well, using the ERAS care pathways
a patient can expect to experience an
enhanced recovery after their bowel
surgery. These pathways include removing
the catheter on the fi rst day after surgery,
chewing gum to increase bowel motility,
getting patients to ambulate sooner and
having patients more involved in their care
through preoperative education. Throughout
the two-year research study, the team
is collecting data on metrics including
length of stay, readmission rates, shortand
long-term complications, mortality and
quality of life.
4 2016 COMMUNITY HEALTH BULLETIN