Description
In this talk by Alasdair Santini on Enhanced Recovery After Surgery, the concept of enhanced recovery—which has been in practice for approximately 25 years—was elaborated. Santini traced its origins to a 1997 paper by Kehlet pertaining primarily to abdominal and colorectal surgery, aiming to address factors delaying postoperative recovery. The structured approach to enhanced recovery is divided into three critical phases: preoperative, intraoperative, and postoperative.
During the preoperative stage, Santini highlighted the importance of patient education and assessment of overall health, including cardiovascular, renal, and metabolic considerations. Key strategies include optimizing nutritional status, managing pain effectively, and minimizing fasting to maintain the patient's strength and resilience. Operational protocols now advocate for preoperative carbohydrate loading, analgesia, and thromboprophylaxis to mitigate complications.
In the intraoperative phase, the focus shifts to anesthesia management, where strategies like shorter general anesthetics and local infiltration techniques are employed to reduce complications and enhance recovery. Maintaining correct fluid balance and preventing blood loss through controlled hypotension and blood salvage techniques are also crucial.
Postoperative care continues the focus on effective pain control and early mobilization to prevent complications related to immobility, improving patient outcomes in joint surgeries like knee and hip replacements. He discussed findings from recent studies and meta-analyses indicating the effectiveness of enhanced recovery protocols in reducing length of hospital stays, complications, and blood transfusions, particularly noting their benefits for elderly patients.
Overall, Santini emphasized the need for a comprehensive approach that enhances recovery across all surgical stages, which has been shown to improve outcomes and patient satisfaction.