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October 17, 2013

Helping abdominal surgery patients recover sooner

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A new recovery program for abdominal surgery patients at University of Virginia Health System is helping patients go home sooner while making them more comfortable both before and after surgery.

Abdominal surgery patients typically need at least five to six days of recovery time before heading home from the hospital, said UVA colorectal surgeon Traci Hedrick, MD. One reason for the recovery time is that many patients develop an ileus – a condition that affects the patient’s bowels and makes it difficult to eat. “If you can’t eat, you can’t be discharged from the hospital,” said UVA anesthesiologist Bob Thiele, MD.

Two main causes of an ileus, Thiele said, are giving patients powerful pain medications known as opioids and large amounts of intravenous (IV) fluid following their surgery. The IV fluid can cause swelling and make it harder for patients to move around following surgery.

An Enhanced Recovery Program

UVA’s team took several steps to improve the recovery process:

To reduce the need for IV fluid, UVA abdominal surgery patients are allowed to have sports drinks up to two hours before their surgery and immediately following surgery.  Opioid pain medications have largely been replaced with non-narcotic medications such as acetaminophen. Patients are required to get out of bed and move around. Patients need to be out of bed for six hours on the first day following surgery and eight hours on the second day.

The recovery program takes a team effort from across the Health System, including UVA anesthesiologists, colorectal surgeons, the pre-admission testing center and nurses who care for the patients before, during and after surgery.

“Our staff is really enthusiastic about the program,” Hedrick said. “We’re asking them to do more, such as getting patient out of bed in the recovery room, but they’re happy to do it because it helps the patients.”

About 20 patients have participated in the recovery program so far, Hedrick said. They are typically leaving the hospital two to three days sooner and have told UVA staff they’re better able to manage their pain following surgery.

One Patient’s Experience

Lynn Gaffey came to UVA Medical Center in August for abdominal surgery to remove a benign tumor. A UVA nurse who has helped patients recover from abdominal surgery, she expected a hospital stay of several days and some pain following her surgery. She was pleasantly surprised by how she felt following her abdominal surgery.

“My pain was incredibly well-controlled – better than following the less-invasive surgery I have had previously,” she said.

She was sitting up in a chair about four hours after her surgery, and was walking the halls of the hospital the following morning. After having her surgery on a Friday morning, she was discharged on Monday morning. Her at-home recovery continued to progress well without any problems.

“It was just so much easier than I thought it would be,” Gaffey said.

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