Claudia Shi | November 15, 2022
Beginning in August 2022, Vanderbilt University Medical Center (VUMC) expanded their enhanced recovery after surgery (ERAS) program to benefit an additional 1,400 yearly patients who undergo total joint replacement. The ERAS program was first introduced in the 1990s in Denmark and quickly spread internationally. The program was adopted by Vanderbilt University Hospital and the children’s hospital at Vanderbilt in 2014 and 2015, respectively.
Since its first beginnings, VUMC’s ERAS program has seeked to enhance surgical recovery and shorten patient (both adult and pediatric) hospital stays in the Vanderbilt University Hospital or Belle Meade Surgery Center. To achieve this, VUMC has adopted several intraoperative and postoperative adjustments.
To begin, ERAS uses minimally invasive surgery and strong local anesthesia during surgeries. Minimally invasive surgical approaches can reduce patients’ physical stress during the surgery and potential complications.
Minimally invasive knee replacement is usually done by making a shorter incision that creates less tissue damage. After making the cut, damaged bones are removed, and metal implant is cemented to healthy bones. Then a plastic spacer is placed between the implants to allow easier movements.
ERAS also aims to minimize the usage of opioid medications during postoperative recovery management. Opioids relieve pain but interfere with patients’ healing efficiency. It has been found that opioid exposure is directly correlated with wound dehiscence in postoperative patients by hindering generation of new blood vessels, immune activation, and tissue oxygenation. Discontinuing opioid usage also avoids other side effects such as nausea, sedation, irregular sleeping patterns, so that patients can return to their normal schedule and eating habits as soon as possible.
Pathway development and monitoring of patient data have also been crucial in implementing these adjustments. Since its inception at Vanderbilt, ERAS has adopted six ERAS clinical pathways for major surgical procedures for adult patients and seven ERAS clinical pathways for pediatric patients. These ERAS pathways include improvements such as more thorough pre-operation communication and earlier interventions for high-risk patients. Overall, ERAS has already achieved remarkable results in improving patient outcomes.
Continuous improvement can only be achieved with the combined efforts of the fields of nursing, technology, pharmacy, and surgical care. In ERAS, surgeon champions and nurse champions are selected and tasked with educating remaining staff to ensure that the best medical practice is delivered.
ERAS makes sure that all nurses know how to prepare for surgery and how to take care of patients after surgery. In addition, it ensures that all surgeons are kept up to date with new pathways in order to establish the best practice model. Evaluation for individual patients is also taken at least on a quarterly basis. Patient feedback, both physical and mental, is crucial for continually improving ERAS health plans.
Warren Sandberg, the executive sponsor of ERAS, said, “We want consistent and continually improving care practices to become the routine for all surgery. In other words, we want ‘enhanced recovery’ to become simply ‘recovery.’” With more refined clinical pathways and surgical protocols, ERAS is taking another step towards normalizing enhanced recovery, dedicating towards minimizing patient physical and psychological pain after surgery.
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