Description of Service
The enhanced recovery programme was developed in Copenhagen by Professor Henrik Kehlet, and has been used in the UK since January 2002. Within St Mark’s Hospital there has been an enhanced recovery programme since March 2006. All colorectal surgeons at St Marks Hospital use the enhanced recovery programme when appropriate (there are some cases, for example repair of enterocutaneous fistulae, in which the programme would not be appropriate).
Enhanced Recovery can be used with laparoscopic or open surgery to optimise rehabilitation following major surgery. The programme works by modifying many aspects of the intervention and recovery; the term ‘multimodal rehabilitation’ has been applied to this, as there are many factors that are necessary to aid recovery.
An Overview of the Enhanced Recovery Programme
The Outpatient Clinic
Written and verbal advice is provided in the outpatient pre-assessment/pre-admission clinics. The aim of the pre-assessment visit is to ensure we know the relevant facts about the patient’s health and to answer any questions that they may have. Pre-assessment is undertaken by the outpatient sister and nurses and, when necessary, may involve one of the medical staff. The assessment will include a physical examination, blood tests and swabs for MRSA (methycillin resistant staphylococcus aureus) screening. All aspects of the hospital stay, operation and discharge will be explained at pre-assessment. A form that gives consent to surgery will need to be signed either at pre-assessment or at another time before the operation.
Preparing for Surgery
Before surgery patients are generally encouraged to eat and drink normally. A period of starvation is only necessary just before the operation. Additionally, most operations do not require the bowel to be prepared by cleaning it out with laxatives taken by the mouth before surgery. Pain relief has been improved within the programme, with less need for drugs which cause side effects.
People are asked to take a carbohydrate rich drink called preOp© before their operation. This helps contribute to a faster recovery time.
Research shows that taking food and moving around after surgery improves recovery. Patients are therefore encouraged to eat and drink, as well as sit out of bed on the day of surgery, provided their operation is not too late in the day. They will also usually be able to walk around the ward the day after surgery.
As the recovery will improve using this programme, people will generally only need about 3 to 4 nights in hospital after their surgery, particularly when it can be performed using a ‘keyhole’ (laparoscopic) technique. It is important to plan for this discharge date as transport home will need to be arranged. A specific discharge date will be given to individuals before they are admitted to the hospital.
After Being Discharged
Patients normally return to the outpatient department between two weeks and two months after their surgery – the length of time depends upon the type of operation undertaken and the reason for that operation. At this clinic visit the surgeon will review the patient, checking that progress is satisfactory and informing them about further treatment and follow up, if required.
Most people will have made a full recovery within two to six weeks of laparoscopic surgery. Recovery can take a little longer after open surgery. Patients can usually resume normal activities, with the exception of heavy lifting and contact sports, after the above time periods including driving, resuming work and restarting sexual relations.
Next page: Day-to-Day Patient Stay