Torrance Memorial Medical Center anesthesiologist Mark Ancheta, MD, is
hoping to transform how patients are cared for before, during and after
surgery. Doctor’s orders in the past have called for fasting after
midnight the night before and restricting physical movement immediately
But an evidence-based approach to surgical care called Enhanced Recovery
After Surgery (ERAS) is changing long-standing surgery practices. “It’s
a paradigm shift from the way we have been taking care of surgery patients
for decades,” says Dr. Ancheta, who is championing implementation
of the ERAS protocol here.
The goal of ERAS is to get patients back to their normal selves as quickly
as possible after surgery. And the patient plays an active role in that
aim, beginning with how they prepare for surgery. “Patients should
speak with their primary care physician about ways to optimize their health
before the operation—for example not smoking a month before surgery,
limiting alcohol and making sure to exercise,” Dr. Ancheta advises.
With the ERAS protocol, patients are also allowed to eat up to eight hours
before their scheduled surgery time and drink a complex carbohydrate liquid
recommended by their doctor three hours before, making for a happier patient
who is not starving prior to their surgery and who feels better in recovery.
“Ideally by the time the patient gets to the hospital, they will
have done all these things,” Dr. Ancheta says.
ERAS is also in place during the operation, with the anesthesiologist limiting
intravenous fluids and removing unnecessary drains to decrease the risk
of infection. Afterward pain is controlled with an epidural, nerve block,
non-narcotics and/or low-dose narcotics. Patients are encouraged to sit
up and walk within hours.
“Gone are the days of bed rest after surgery. You have to be active
if you want to get out of the hospital faster,” says Dr. Ancheta.
ERAS has been in place in Europe for more than 15 years. It was first used
with colorectal surgery but is becoming more common with gynecological
oncology, bariatric surgery, cystectomies and the Whipple procedure for
pancreatic cancer. In the past five years hospitals in the United States
have begun to follow suit—Duke University Hospital and Mayo Clinic
were among the first to pioneer it.
Studies have shown that ERAS shortens the patient’s time in the hospital,
decreases the risk of complications and increases patient satisfaction
because they’re back to their normal productivity more quickly.
Hospitals have seen reduced costs and no increase in readmission. ERAS
was officially implemented at Torrance Memorial in the fall by Dr. Ancheta
and his team. They are currently collecting patient satisfaction and other
data to demonstrate program success here. He worked with Deb Butler, RN,
director of perioperative services, for three years to get the ERAS protocol
in place. They formed a multidisciplinary committee composed of dietitians,
nurses, surgeons and anesthesiologists to ensure seamless integration.
“We wanted to get as many departments involved as possible because
ERAS involves the entire continuum of surgical care,” he says.
Collaboration and communication are critical because ERAS measures need
buy-in from all peri-operative team members in order to be effective for
the patient and for the hospital. Patient education is also essential.
But transitions are not always easy, Dr. Ancheta acknowledges.
“This is a cultural and mental shift that challenges years of surgical
doctrine, but it’s very exciting at the same time.”
Dr. Ancheta has been on staff at Torrance Memorial for 11 years and says
he especially appreciates the collegial environment and the strong relationships
with surgeons and the nursing staff. He’s also proud to lead the
charge in changing the traditional way the hospital approaches care for
its surgical patients.
“Hopefully we’re making a positive difference in terms of earlier
hospital discharge, less postoperative surgical complications and improved
patient well-being,” Dr. Ancheta says. “Torrance Memorial
is a progressive hospital, and we’re always looking ahead. So ERAS
shouldn’t be something we wait to do in the future.
“The future is here. And it is the best thing for the patient.”