The University Health System has introduced a new procedure that changes the way patients recover from certain surgeries. In the past, going into the hospital for colorectal surgery meant staying in the hospital for five or six days. But with a new procedure the University Health System has introduced, patients return home in three days or fewer.
What does it take to get a patient who’s just had surgery on their colon up and out of the hospital in three days? An overhaul of the method used for the last 50 years and a bit of common sense.
Traditionally, colorectal surgery patients were put on morphine drips. And while morphine is a fairly standard painkiller in hospitals around the world, it poses some serious problems for patients recovering from colon surgery, as well as other surgeries that affect the generally sensitive digestive tract.
“Opioids [like morphine] are notorious for causing constipation,” said Asst. Surgery Prof. Dr. Traci Hedrick, a colorectal surgeon. “After surgery, this can result in an ileus, in which the bowels are basically paralyzed, and the person can’t eat or hydrate themselves for about five days.”
The new method replaces opioids with non-narcotic pain killers such as acetaminophen, the active ingredient in Tylenol and Midol. In addition to allowing patients to eat following the surgery, the new medications may actually be more effective at controlling pain.
Dr. Robert Thiele, assistant professor of anesthesiology and biomedical engineering, brought this new method from Duke University, where he was recently a fellow.
“When I came back, I talked to [Hedrick] about implementing [this method], because it mostly involves colorectal patients, and she’d been looking for a grant,” Thiele said. “She didn’t get the grant, but we decided to go for it anyway.”
The move away from opioids combined with the fact that patients are now allowed to have sports drinks up until two hours before and immediately after surgery, reduces the need for patients to be connected to an IV drip.
This tactic allows patients to be up and moving around much sooner. The day after surgery, they are now required to spend six hours out of bed the day after the procedure and eight hours the following day — with a great deal of assistance provided by hospital staff. By reducing the amount of time spent in bed, the new methods also reduce costs by around $2000.
“If a patient goes home sooner, it costs the hospital less, costs the patient less and they get back to work sooner,” Thiele said.
Since the actual surgical procedures will remain the same, there should be no change in insurance coverage, Thiele said.
Thiele and Hedrick say the University’s program is probably only the third institution in the country to implement this type of procedure, following the Duke University Hospital and the Mayo Clinic.
“It’s vastly different than the way we … have taken care of patients for the last 50 some years,” Hedrick said.
New procedures typically take about 10 years to be adopted by the medical community at large, Hedrick said, because when lives are on the line, people tend to stick to “tried and true” methods.
Thiele credits the Health System’s ability to adopt and adapt to new methods to the fact that it is a school as well as a hospital, meaning it is constantly welcoming new people and new information so as not to teach its students outdated material.
“Most physicians don’t work at teaching hospitals,” Thiele said. “If you are an ER doctor in Culpeper, you don’t have residents, you don’t have medical students. If you work in private practice, you either have to spend your personal time looking new things up or wait for a younger colleague to be hired.”
Colorectal surgery is an increasingly necessary procedure across the country, Hedrick said, with colon cancer coming in as the third leading type of cancer in the United States. Other colon conditions, such as irritable bowel syndrome and diverticulitis tend to affect younger people as well.
Although this method is still new, it is possible similar recovery methods could be used on patients recovering from other gastrointestinal and orthopedic surgeries in the future.
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