Enhanced Recovery After Bariatric Surgery
For patients undergoing any type of surgical procedure, Fast-Track Surgery, or Enhanced Recovery After Surgery (ERAS) are synonymous terms describing one of the latest innovations in modern medicine. Evidence-based integration of a “multi-modal” approach effectively reduces the physiologic stress response to surgery and results in faster recovery and less postoperative pain for patients. In light of the recent opioid epidemic, reducing a patient’s needs for narcotic medications after surgery may in turn lead to reducing the number of people dealing with narcotic addiction. Fast-Track Surgery/ERAS protocols are gaining popularity among surgeons and patients alike because they are associated with better surgical outcomes, decreased complication rates, decreased hospital length of stay, reduced lost days of work, and ultimately happier, healthier patients.
Fast-Track Surgery/ERAS consists of three phases: the Pre-surgery or Pre-Habilitation Phase, the Intraoperative Phase, and the Postoperative/Recovery phase. All are equally important and work synergistically to speed surgical recovery.
The Pre-Habilitation Phase involves evaluation and optimization of the patient’s existing nutritional and fitness status, as well as reducing and/or controlling co-morbid medical conditions such as heart disease and diabetes. Smoking cessation at least 4 weeks prior to surgery is key to reducing risks of DVT and PE blood clots, postoperative pneumonia, and problems with wound healing. Nutritional optimization with high-protein foods combined with strength training has been shown to augment resiliency after surgery.
The Intraoperative Phase consists of seamless integration of the Anesthesia, Nursing, and Surgical teams to achieve an efficient operation and minimize time spent under general anesthesia. This in turn facilitates the patient’s ability to begin early ambulation and early return to oral nutrition. There are many protocols for Multi-modal analgesia, which utilize non-narcotic pain medications (such as Tylenol and gabapentin)—sometimes given even before surgery—together with regional nerve blocks to help reduce the requirements for narcotic pain medications and subsequently the untoward side-effects of these medications which include include nausea, vomiting, and severe constipation.
The Postoperative Phase begins in the recovery room, and continues until the patient is back to his/her level of normal function. Recovery is an ACTIVE process, not a passive one, i.e. patients must make a concerted and consistent effort to walk several times daily, keep pain levels under control with oral medication regimens that mainly consist of non-narcotic mediations, and use narcotics only for severe pain. Patients must also monitor their nutrition and hydration status at home and be sure they are on target with daily goals. Constipation can be a common side effect of surgery, and patients must pro-actively monitor and prevent constipation from becoming a serious problem by taking a bowel regimen. Activity restrictions differ depending on the type of surgery, but in general, returning to normal daily activity as soon as possible is recommended, with light exercise as tolerated and/or directed by the surgeon.
The result? You. Better. Faster.
If you are facing elective surgery in the near future, seek out a surgeon and/or program that has an active Fast-Track Surgery/ERAS protocol in place. You’ll be better because of it.