Enhanced Recovery and Fast Track Surgery

ENHANCED RECOVERY AND FAST TRACK SURGERY

The concept of enhanced recovery after surgery was first pioneered by Henrik Kehlet, a Danish colorectal surgeon, over a decade ago. The implementation of this managed care process, based on best practise, and delivered by a multidisciplinary healthcare team results in improved outcomes for patients; specifically, a faster recovery time and shorter hospital stay.

The benefits of a comprehensive enhanced recovery programme have been demonstrated in colorectal, endocrine, gynaecological, urological, vascular and orthopaedic surgeries. Several detailed guides are available to surgical teams wishing to implement an Enhanced Recovery programme [1].

 

Six stages of the perioperative process have been identified:

  1. Referral
  2. Pre-operative care by the hospital team
  3. Admission to hospital
  4. Operative care
  5. Post-operative care in the hospital
  6. Follow-up – rehabilitation and discharge

Evidence-based care modalities are combined to create a protocol to markedly decrease postoperative
morbidity (such as hospital acquired infections and venous thromboembolism), decrease length of hospital stay, and decrease time to resumption of normal daily life.

There are three key evidence-based interventions that when implemented by surgical teams during ‘operative care’ combine to enhance the recovery of patients, these are:

  • Minimally invasive surgery: Shorter incisions and laparoscopic surgical techniques reduce the stress of surgery.
  • Intraoperative fluid management: Oesophageal Doppler guided fluid management has been shown to reduce complications, reduce intensive care admissions and reduce length of hospital stay.
  • Modern anaesthesia and pain relief: Modern anaesthetics and better pain relief allowing faster postoperative mobilisation and therefore recovery.

These individual interventions are more effective when implemented together than alone – ‘the sum is greater than the parts’.

Scott, Fearon, DOH

Reference

NHS Enhanced Recovery Partnership Programmme. Fulfilling the potential: A better journey for patients and a better deal for the NHS, 2012.