Features  |   December 2014
Optimized Perioperative Care: Why Is Change So Difficult? And What Can We Do To Overcome Barriers?
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Education / CPD / Gastrointestinal and Hepatic Systems / Pain Medicine / Quality Improvement / Features
Features   |   December 2014
Optimized Perioperative Care: Why Is Change So Difficult? And What Can We Do To Overcome Barriers?
ASA Monitor 12 2014, Vol.78, 14-16.
ASA Monitor 12 2014, Vol.78, 14-16.
If you don’t know where you’re going, any road’ll take you there.”
– Alice in Wonderland
Enhanced recovery after surgery (ERAS®), “fast-track surgery,” or optimized perioperative care (OPC) is an evidence-based perioperative clinical pathway developed to accelerate functional recovery of surgical patients.1  The goal of OPC is to reduce the incidence of postoperative symptoms and non-surgical complications through the use of minimally invasive surgical techniques, multimodal opioid-sparing pain management strategies, optimized fluid therapy, and adjustment of surgical care principles (question routine use of tubes and drains) and enhanced nursing care practices incorporating early mobilization and oral feeding. Furthermore, these changes to surgical care practices have been shown to accelerate functional recovery, increase patient satisfaction and safety after discharge with no increase in re-admission rates or post-discharge complications, and reduce the length of hospital stay. In addition to immediate postoperative benefits, an OPC program has been shown to reduce early postoperative fatigue (POF) and the consequences of fatigue, thereby promoting earlier return to normal functioning following surgery.2  In this context, POF has been an underappreciated factor in the recovery profile after major cancer surgery, as POF typically lasts longer than pain and prevents otherwise fit patients from returning to work and possibly from resuming their planned postoperative (adjuvant) therapies. While initially studied to a greater extent in open colorectal procedures,3,4  these “multi-modal OPC programs” have offered beneficial results in liver,5  pancreas,6  esophageal7  and pelvic8  surgeries as well.
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