Enhanced recovery programs inform patients while decreasing pain, length of stay

Preparing patients before surgical procedures with enhanced recovery after surgery (ERAS) programs boosts patient knowledge while reducing recuperation time and decreasing the need for drug interventions, according to the results shown at two different healthcare facilities.

ERAS programs incorporate an array of different methods to teach patients, reduce pain and speed recovery. The programs also use combination therapies to treat postoperative pain in new ways. ERAS approaches span the entire surgical process to achieve reach these goals.

Less pain in knee surgery

The first example comes from Chicago's Rush University Medical Center, which utilizes an ERAS program for patients receiving minimally invasive knee replacement surgery. The 243 participants in the program were given a combination of differently functioning pain medications, instead of a single drug, to ease discomfort. Patients rated their pain levels through the surgical process using an 11-point scale to see if they faced less pain than the usual 60 percent of those who previously reported having moderate to severe pain.

Results showed that only four percent of patients reported having moderate to severe pain, while 29 percent did not experience pain at all. Patients were discharged an average of 15 hours after surgery, a quick turnaround from the average 3.7 days.

"Comprehensive collaboration between the physician anesthesiologist and surgical team enables us to discharge patients earlier with the same outcomes but less pain," said Asokumar Buvanendran, MD, lead author of the study and director of orthopedic anesthesia at Rush University Medical Center. "Using multi-modal therapies and ERAS principles have revolutionized pain management."

Patient knowledge leads to shorter stays

The second scenario occurred at Beaumont Health, in Royal Oak, Michigan, where ERAS was used to educate patients before colorectal procedures (prehabilitation). Of the  228 patients who took a 10-quesiton survey to analyze their preparation for surgery and their involvement in their care, 160 of these patients participated in prehabilitation classes of the ERAS program and 68 did not.

Results showed that 91 percent of those who participated in ERAS felt prepared for surgery, compared to the 80 percent who had not taken the class. More than 95 percent of ERAS patients felt knowledgeable about recovery, while only 82 percent of non-ERAS patients felt the same. Overall, ERAS was able to reduce the length of stay to from a week to two to three days, and patients took less opioids for pain management.

"We believe patient education is a foundation of the ERAS model and should be a standard part of the pre-surgery protocol," said Larry Manders, MD, lead author of the study and an anesthesiology resident at Beaumont Health. "Some surgeons initially were skeptical but, after seeing the patient benefits, all are now believers in ERAS and providing patient education prior to surgery."