Fast-track surgery
Fast-track surgery, also known as enhanced recovery after surgery (ERAS) or enhanced recovery programs (ERP), is a progressive approach to surgical care aimed at minimizing recovery times and hospital stays following surgery. Developed by Professor Henrik Kehlet in the 1990s, this method emphasizes a comprehensive strategy that includes preoperative nutrition, counseling, and postoperative mobilization. Prior to surgery, patients are encouraged to consume carbohydrates and stay hydrated, deviating from traditional fasting practices. During the procedure, short-term anesthetics are utilized, and patient body temperature is carefully monitored to enhance recovery.
Post-surgery, patients are prompted to engage in normal activities quickly, such as eating and moving, which can aid in digestive recovery and reduce complications. The protocol also emphasizes avoiding fluid overload and managing pain effectively. While fast-track surgery has been successfully implemented in various surgical fields, such as vascular and thoracic surgery, its adoption has not been universal, leading to differing opinions among medical professionals regarding its application. Overall, this approach has been associated with improved recovery outcomes, including reduced complications and shorter hospital stays.
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Fast-track surgery
Fast-track surgery is an altered set of surgical procedures designed to reduce postoperative hospital stays and recovery times. Before surgery, the patient's preoperative nutrition is changed so that he or she ingests mainly carbohydrates and water. During surgery, short-term anesthetics are used and the patient's body temperature is carefully maintained. After surgery, the patient is pushed to resume normal activity, such as oral nutrition and movement, as soon as possible. The patient is also monitored to ensure that he or she is not overloaded with fluids or salt.
Overview
Initiated by Professor Henrik Kehlet in the 1990s, fast-track surgery, also called enhanced recovery after surgery (ERAS) and enhance recovery programs (ERP), is a set of pre-surgery, surgical, and post-surgery tactics designed to reduce the amount of time a patient spends recovering after surgery. While fast-track surgery has become a staple in many procedures, including vascular surgery, thoracic surgery, and radical cystectomy, its spread throughout the medical community has been slow.
The fundamentals of fast-track surgery include optimizing nutrition, preoperative counseling, postoperative counseling, early mobilization, and standardized analgesic and anesthetic regimens. Some fast-track surgery programs also avoid perioperative fasting and instead encourage eating large quantities of carbohydrates.
The first part of fast-track surgery is preoperative counseling. During this event, a nurse or doctor briefs the patient about whatever surgery he or she intends to undergo, and then answers any questions that the patient may have. Following that, instead of fasting before the surgery, the patient eats significant quantities of carbohydrates and drink water. The patient then takes antibiotics.
During a fast-track surgery, the patient is given only short-term anesthetics. This allows for a speedier recovery after surgery. The doctor avoids overloading the patient with salt or water, does not use drains, and may use warmed intravenous fluids to maintain the patient's body temperature.
After surgery, the doctor ensures that the patient does not have a salt or water overload and is not nauseous or vomiting. The patient is instructed to resume normal activity as soon as possible. This includes early removal of any catheters, early oral nutrition, and early mobilization, which helps stimulate gut motility. In some cases, the patient is instructed to chew gum soon after surgery. This tricks the body into believing that it needs to digest food without putting strain on the digestive tract.
If carried out correctly, fast-track surgery often results in a faster recovery than traditional surgery. However, the process has not been adapted to all surgical procedures, making some medical professionals hesitant to utilize it. Fast-track surgery has been shown to reduce bowel-related postoperative complications, as well as surgical stress and hospital stays.
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