Many runners swear by a practice called carb-loading, or bulking up on carbohydrate-rich food before a long race, as a way to fortify their bodies, prevent them from breaking down in the middle of the run and guard against injuries that will haunt them afterward. Much like those advance preparations, evolving pre-surgery programs are helping patients recover from invasive operations more quickly, in part with a fortified diet before surgery and limited use of narcotics after it. Research suggests the new approach is reaping dividends, leading to improved outcomes for surgical patients worldwide.
First introduced in Europe, enhanced surgical recovery programs have been gaining traction in the United States over the past two years, says Randall Craft, MD, Chief of Surgery and Medical Director of Plastic Surgery and Wound Care at Cancer Treatment Centers of America® in Goodyear, Arizona. The approach marks a paradigm shift from the accepted norms of just five years ago, emphasizing changes to nutritional and pain management protocols that are yielding significant patient benefits, he says. A March article in The Journal of the American Medical Association (JAMA) reported that enhanced surgical recovery programs have resulted in 30 percent to 50 percent shorter hospital stays among surgical patients and similar reductions in patient complications.
New methods for better results
The shift in protocols requires a strong emphasis on education. “Many patients believe they’ll have to be in the hospital for a long time after surgery, and expect recovery at home to take a few weeks,” Dr. Craft says. “They also expect that they won’t be allowed to eat before or after surgery. With this newer approach, we have to explain to patients how scientific advancements over the past few years have found that, for the most part, those old precautions aren’t necessary, or even helpful. Recovery is actually better in many cases when you take in nutrients before surgery, and eat and get up and move as quickly as possible after surgery.”
When breast cancer patient Beth Dunlop, 59, of Naperville, Illinois, learned she had a mass in her colon, she feared she wouldn’t be able to take a scheduled wedding anniversary trip to Paris. The trip had already been delayed by three years because of her breast cancer treatment. Dunlop’s doctor at CTCA® at Midwestern Regional Medical Center, Surgical Oncologist Hatem Halabi, MD, FACS, recommended she try the Advanced Surgical Recovery (ASURE) program at CTCA when having the colon mass removed. Dunlop agreed. The mass turned out to be benign, and Dunlop left the hospital two days after surgery. Four weeks later, she was on a plane to Paris. “The difference was night and day compared to my previous surgeries,” she says.
The ASURE program at CTCA
With ASURE and other enhanced surgical recovery programs, patients typically meet with dietitians before their surgery to discuss changes they can make to their diet beforehand to help them maintain the strength and nutritional balance they need to get through, and recover from, surgery more easily. The morning of surgery, patients often are advised to drink a carbohydrate-rich beverage. They also may be given pre-surgical anesthesia or other non-narcotic numbing medications, either by injection or via a catheter, to reduce the risk of inflammation after surgery. “They trick the body into not triggering an inflammatory response,” Dr. Craft says of the medications.
Program protocols also recommend that doctors give patients less fluid than they did in the past, to help avoid forcing the body to respond to an overload of fluid after surgery. Another major difference maker in the new programs is in managing post-surgical pain without the use of prescription drugs. “The primary way to deal with pain after surgery in the past was through narcotics,” Dr. Craft says. “Recently, though, there’s been a big push nationally to reduce narcotic use in medicine because of addiction issues, and also because they’re just not needed in all the cases for which they’re prescribed. By using other medications like acetaminophen, for example, patients are typically more alert when they wake up and recover faster.”
Dunlop says she appreciated not having to take a bunch of different medications after her surgery. “After all the chemotherapy drugs you have to take, it was wonderful to not have more drugs pumped into my system,” she says. “I realize that drugs are a necessity when you are fighting cancer, but they can have long-term effects, so it was really nice to do without the powerful medications during this surgery, and I still recovered quicker.