A new recovery program for surgical patients at the University of Virginia Health System is helping patients go home sooner while making them more comfortable both before and after surgery.
Learn more from Dr. Traci Hedrick, a UVA surgeon who helped put the new procedure in place.
Enhanced Recovery After Surgery
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Traci Hedrick, MD
Dr. Traci Hedrick is a colorectal surgeon who specializes in caring for patients with colorectal cancer and other colorectal conditions with minimally invasive surgery.Learn more about UVA Cancer Center
Transcription:
Enhanced Recovery After Surgery
Melanie Cole (Host): A new recovery program for surgical patients at the University of Virginia Health System is helping patients to go home sooner while making them more comfortable both before and after surgery. My guest today is Dr. Tracy Hedrick. She is a colorectal surgeon who specializes in caring for patients with colorectal cancer and other colorectal conditions with minimally invasive surgery. Welcome to the show, Dr. Hedrick. So tell us a little bit about some of the typical challenges that are faced by patients when they are recovering from colorectal surgery.
Dr. Tracy Hedrick (Guest): Yes, thank you. So, colorectal surgery itself can be quite complex and patients typically after surgery, you know, as from any surgery, can have pain after surgery but also can have problems with their bowel becoming awake after surgery, so it’s oftentimes that patients are in the hospital four to five days waiting for their bowel function to return. What enhanced recovery does is allow that process occur much more quickly.
Melanie: Wow. So what can people expect? I know you doctors, you want the bowels to return, you want to make sure that they are passing gas and having a bowel movement, whatever it is that they have had done, before you let them even think about leaving the hospital. When do they get up and start moving around? Does that help speed the process?
Dr. Hedrick: Yes, absolutely. So, with this new protocol, in fact, we get them up and moving around in the recovery room because we know that that stimulates the bowel to function. So we get them up in the recovery room and then once they get to the hospital ward, we get them up again and we get them up two and three times on the day after surgery. That is very important.
Melanie: What about eating? Do they start eating solid food pretty quick? Do they have to take laxatives, stool softeners for quite a while afterward, or is this just initially?
Dr. Hedrick: Before, we used to wait until the patients were passing gas to actually feed them, but with the new protocol they get liquids the night of surgery, jello and that type of thing, and then the next day they are started on solid food. You know, patients are very good at regulating themselves. Since they are nauseated, they don’t take the food but most patients are able to tolerate soft food the day after surgery.
Melanie: You’ve helped pioneer some of the changes in the recovery process for abdominal surgeries. Can you explain how the enhanced recovery after surgery process works a little bit for us?
Dr. Hedrick: Yes. You know, each protocol is a bit different at each institution, but it’s basically based on several tenets,and that is, one is avoiding the use of opioids such as morphine which can slow the bowel down after surgery, so we use different types of pain medicines to control pain such as ibuprofen and Tylenol and gabapentin and things like that. It’s also based on avoiding giving the patients a lot of intravenous fluids, saline, through their veins, so we let the patients drink up until two hours prior to surgery and then we allow them to drink in the recovery room to keep themselves hydrated. It’s also based on, as we discussed, getting up and walking right after surgery and also eating right after surgery. Finally, it’s really based on allowing the patients and their family to be an active participant in their care, so we tell them exactly what is going to happen, we give them a checklist so that they know what is going to happen, and they help us to remind the nurses to get them up after surgery, and really make them the star player of their care.
Melanie: What are some of the benefits for the patients of this enhanced recovery process? Does it help them to go home quicker? Does it help their families care for them post-surgery?
Dr. Hedrick: Yes. So it helps them, on average, go home two days sooner; it helps them be prepared to go home sooner. It actually controls their pain better and it allows them really to get back to their normal selves much quicker.
Melanie: What do their families and loved ones need to know about post-surgical care and taking their loved one home? Are their certain things you like to teach them about their incisions or about things they should be looking for, red flags?
Dr. Hedrick: Yes. So, you know, a lot of times families want to keep their loved ones in bed and do everything for them. I personally think it’s better for the patient to be up and active as much as possible after surgery. There are red flags: We want to know anytime the patients have a fever, anytime they start to develop flu-like symptoms, things like that. But outside of that, we want them to be up and active, taking walks and doing the likes, because that really does speed up the recovery process.
Melanie: And so if they have these red flags, obviously they call you right away. Are there certain candidates, certain patients that you have that have surgery that are not candidates for this enhanced recovery program?
Dr. Hedrick: No. Really we do put everybody on the protocol, even the sickest of patients that have certain medical conditions. We monitor them very closely; we don’t send them home before they are ready. The key is not to discharge patients before they are ready. It’s to get them to the process where they feel like being discharged sooner than before, and so if they are not quite ready, we don’t send them home. But, you know, the key is standardizing the care process and we do it for the young 19-year-old patients to the 90-year-old patient. We do customize it to each individual person that everyone benefits from the protocol.
Melanie: So tell us in just the last few minutes your best advice for people that are considering having surgery, what to expect afterward and why patients should come to UVA for their surgical care.
Dr. Hedrick: Well, I think we pride on ourselves on providing the most up-to-date quality care. You know, this protocol has been proven to be effective, in not only reducing the link to stay but also reducing complications, and we are becoming a center now for teaching other institutions how to do this protocol. I think for all those reasons, patients should choose UVA for their health care needs.
Melanie: Thank you so much, what great information. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Enhanced Recovery After Surgery
Melanie Cole (Host): A new recovery program for surgical patients at the University of Virginia Health System is helping patients to go home sooner while making them more comfortable both before and after surgery. My guest today is Dr. Tracy Hedrick. She is a colorectal surgeon who specializes in caring for patients with colorectal cancer and other colorectal conditions with minimally invasive surgery. Welcome to the show, Dr. Hedrick. So tell us a little bit about some of the typical challenges that are faced by patients when they are recovering from colorectal surgery.
Dr. Tracy Hedrick (Guest): Yes, thank you. So, colorectal surgery itself can be quite complex and patients typically after surgery, you know, as from any surgery, can have pain after surgery but also can have problems with their bowel becoming awake after surgery, so it’s oftentimes that patients are in the hospital four to five days waiting for their bowel function to return. What enhanced recovery does is allow that process occur much more quickly.
Melanie: Wow. So what can people expect? I know you doctors, you want the bowels to return, you want to make sure that they are passing gas and having a bowel movement, whatever it is that they have had done, before you let them even think about leaving the hospital. When do they get up and start moving around? Does that help speed the process?
Dr. Hedrick: Yes, absolutely. So, with this new protocol, in fact, we get them up and moving around in the recovery room because we know that that stimulates the bowel to function. So we get them up in the recovery room and then once they get to the hospital ward, we get them up again and we get them up two and three times on the day after surgery. That is very important.
Melanie: What about eating? Do they start eating solid food pretty quick? Do they have to take laxatives, stool softeners for quite a while afterward, or is this just initially?
Dr. Hedrick: Before, we used to wait until the patients were passing gas to actually feed them, but with the new protocol they get liquids the night of surgery, jello and that type of thing, and then the next day they are started on solid food. You know, patients are very good at regulating themselves. Since they are nauseated, they don’t take the food but most patients are able to tolerate soft food the day after surgery.
Melanie: You’ve helped pioneer some of the changes in the recovery process for abdominal surgeries. Can you explain how the enhanced recovery after surgery process works a little bit for us?
Dr. Hedrick: Yes. You know, each protocol is a bit different at each institution, but it’s basically based on several tenets,and that is, one is avoiding the use of opioids such as morphine which can slow the bowel down after surgery, so we use different types of pain medicines to control pain such as ibuprofen and Tylenol and gabapentin and things like that. It’s also based on avoiding giving the patients a lot of intravenous fluids, saline, through their veins, so we let the patients drink up until two hours prior to surgery and then we allow them to drink in the recovery room to keep themselves hydrated. It’s also based on, as we discussed, getting up and walking right after surgery and also eating right after surgery. Finally, it’s really based on allowing the patients and their family to be an active participant in their care, so we tell them exactly what is going to happen, we give them a checklist so that they know what is going to happen, and they help us to remind the nurses to get them up after surgery, and really make them the star player of their care.
Melanie: What are some of the benefits for the patients of this enhanced recovery process? Does it help them to go home quicker? Does it help their families care for them post-surgery?
Dr. Hedrick: Yes. So it helps them, on average, go home two days sooner; it helps them be prepared to go home sooner. It actually controls their pain better and it allows them really to get back to their normal selves much quicker.
Melanie: What do their families and loved ones need to know about post-surgical care and taking their loved one home? Are their certain things you like to teach them about their incisions or about things they should be looking for, red flags?
Dr. Hedrick: Yes. So, you know, a lot of times families want to keep their loved ones in bed and do everything for them. I personally think it’s better for the patient to be up and active as much as possible after surgery. There are red flags: We want to know anytime the patients have a fever, anytime they start to develop flu-like symptoms, things like that. But outside of that, we want them to be up and active, taking walks and doing the likes, because that really does speed up the recovery process.
Melanie: And so if they have these red flags, obviously they call you right away. Are there certain candidates, certain patients that you have that have surgery that are not candidates for this enhanced recovery program?
Dr. Hedrick: No. Really we do put everybody on the protocol, even the sickest of patients that have certain medical conditions. We monitor them very closely; we don’t send them home before they are ready. The key is not to discharge patients before they are ready. It’s to get them to the process where they feel like being discharged sooner than before, and so if they are not quite ready, we don’t send them home. But, you know, the key is standardizing the care process and we do it for the young 19-year-old patients to the 90-year-old patient. We do customize it to each individual person that everyone benefits from the protocol.
Melanie: So tell us in just the last few minutes your best advice for people that are considering having surgery, what to expect afterward and why patients should come to UVA for their surgical care.
Dr. Hedrick: Well, I think we pride on ourselves on providing the most up-to-date quality care. You know, this protocol has been proven to be effective, in not only reducing the link to stay but also reducing complications, and we are becoming a center now for teaching other institutions how to do this protocol. I think for all those reasons, patients should choose UVA for their health care needs.
Melanie: Thank you so much, what great information. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.