New Approach to Surgical Management Will Accelerate Patient Recovery But Will Challenge Current Practices

A criticism in CMAJ questions historical surgical practices that are not research-based, outlining a multidisciplinary approach called Enhanced Recovery after Surgery (ERAS) that will help patients recover more quickly from surgery. The article, published in CMAJ (Journal of the Canadian Medical Association), examines the evidence supporting the approach and how it could be implemented in Canada.

Enhanced recovery after surgery is an evidence-based treatment program created to improve outcomes for patients with faster recovery. A holistic approach is needed involving family physicians, nurses, surgeons, anesthesiologists, nutritionists, and other health care professionals prior to surgery throughout the recovery period, in order to help patients recover normal operation as quickly as possible.

"ERAS involves changing the way we, as a medical community, think about preoperative, intraoperative, and postoperative care to improve all surgical outcomes," said Dr. Alon Altman, lead author, Gynecologic Oncologist and Associate Professor at the University of Ottawa. 39, University of Manitoba, and Program Director, Obstetrics and Gynecology, Winnipeg Health Sciences Center, Winnipeg, Manitoba.

It has been proven that this drug promotes patient movement after surgery, reduces the number of complications and reduces the length of stay in hospital. It is currently used in some hospitals in Canada and around the world, including the United States and the United Kingdom.

Enhanced recovery after surgery can be broken down into three stages: preoperative, intraoperative (during surgery) and postoperatively. This involves changes such as changing the diet before surgery, stopping certain medications, changing certain procedures during surgery, moving patients within 24 hours of surgery, and so on.

"This approach should be used for all operated patients, the goal being to reduce the patient's stress and allow him / her to function normally," said Dr. Altman.

Canada is increasingly interested in adopting this approach, although difficulties are encountered because of the many different health professionals who need to be involved.

"Despite the difficulties badociated with implementing ERAS, patients and the health system have obvious benefits, including healthier recovery using fewer resources," said co-author Dr. Gregg Nelson, Chief of the Gynecologic Oncology Department, Tom Baker Cancer Center, Calgary, Alberta. and ERAS Alberta Surgical Lead. "A team approach of involving family physicians before patients undergo surgery, through surgeons and recovery staff after hospitalization, is a key element to successful implementation."