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Monday Medical: Easier recovery after surgery


Susan Cunningham
For Steamboat Pilot & Today

Recovering from surgery has never been easier.

Enhanced Recovery After Surgery is a new program offered by hospitals around the country — including UCHealth Yampa Valley Medical Center.

“If I were the patient, this is definitely what I’d want and how I’d want to be treated,” said Dr. Sarah Gebauer, an anesthesiologist at Yampa Valley Medical Center. Gebauer is one of several local doctors who recently worked together to implement the after surgery program at YVMC.

Most hospitals that follow the after surgery experience at least a 30% decrease in both recovery time and complication rates, which include surgical site infections, opioid use after surgery, post-op nausea and vomiting. YVMC has already seen similar improvements.

“We’ve had some really amazing results,” Gebauer said. “Implementing the program has been an enormous effort on the part of doctors, nurses, physical therapists, nutritionists — really, everyone who cares for these patients. The surgeons involved have been leaders in this program and want the most cutting-edge and effective treatments for their patients.”

Below, Gebauer outlines what you can expect if your surgery qualifies for the program.

Before surgery

With Enhanced Recovery After Surgery, education is key before surgery. Patients talk with a doctor or nurse and receive information that helps them better understand the program.

“We want to educate patients about what we’re doing and why we’re doing it,” Gebauer said. “For instance, the reason we give pain medications that are different from opioids is not because we want a patient to be deprived, but because we think having a multi-modal pain approach is better for recovery and overall function.

“And when we encourage patients to get up and move more quickly after surgery, we’re not being mean and making them move while they’re in pain — we’re encouraging them to move because it improves their lung and bowel function, among other things.”

In traditional surgeries, patients are instructed not to drink anything after midnight. But for Enhanced Recovery After Surgery surgeries, patients can drink carbohydrate-containing liquids up to two hours before surgery.

“That helps decrease insulin resistance and decreases muscle breakdown prior to surgery,” Gebauer said.

Additional steps before surgery are also taken to help prevent surgical site infections and blood clots.

During surgery

The anesthesiologist focuses on avoiding opioids and using other pain medications, such as ibuprofen and acetaminophen, when possible. Regional anesthesia, including epidurals and nerve blocks, is used to help decrease the total anesthesia a patient is exposed to.

“We take out any tubes as soon as possible when the surgery is complete to help decrease the risk of infection and get people moving more quickly,” Gebauer said.

Smaller incisions are made when possible. Laparoscopic or robotic surgeries, which can currently be done at YVMC for some gynecologic and urologic procedures, as well as some hernia repairs and colon resections, can help keep incisions small.

After surgery

Patients are encouraged to move and eat more quickly, which helps get the intestines moving. Opioid use is minimized, and a variety of medications are used to treat pain.

Nurses play an important role in all aspects of the program. “The nurses are really doing an amazing job,” Gebauer said. “It’s a lot more work for them at every step of the process. But they believe in it, and they want the best for their patients.”

Patients whose surgeries qualify for the Enhanced Recovery After Surgery program will automatically be enrolled. Currently, surgeries that are eligible for the program include hysterectomies, some colorectal surgeries and some urologic procedures. Soon, joint replacements will also be a part of the program.

If your surgery doesn’t currently qualify for Enhanced Recovery After Surgery, know that aspects of the program are already being incorporated into other surgeries when possible because decreasing stress during surgery helps your body heal faster.

“Stress of surgery leads to a surge in cortisol, which can impact the body in different ways,” Gebauer said. “Anything that decreases the stress your body feels during surgery can help a patient recover more quickly.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.


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