Hospitals are rethinking post-surgical care

If you’ve ever been through surgery, you know the rules. No eating or drinking anything in the 12 to 24 hours prior to the procedure, plenty of IV fluids and heavy narcotics followed by several days of bed rest.

But a growing number of U.S. hospitals have become convinced the evidence doesn’t support these long-followed protocols anymore.

“We’d been starving [patients], pumping them full of fluids,” said Dr. Martin Paul, chairman of surgery at Sibley Memorial Hospital in Northwest D.C. “It’s amazing the interventions that were taken without questioning their benefits.”

Sibley is among several hospitals in Greater Washington starting to rethink care for surgical patients by following the increasing popularity of evidence-based protocol called enhanced recovery after surgery. Adopted across Europe for more than a decade, the protocol is designed to help patients rebound from surgery faster.

Under enhanced recovery, surgical patients aren’t directed to fast but instead are encouraged to load up on fluids and carbohydrates, including Gatorade, as they might for a challenging athletic event. “That sets the whole stage for recovery,” Paul said.

Patients are given short-acting anesthesia during surgery and epidurals to target pain relief. Intravenous fluids are kept to a minimum to avoid salt and water overload. Following surgery, patients are given additional targeted pain relief and other pain medication as an alternative to narcotics. They do not have nasogastric tubes, and staff try to get the patient — typically more alert and less nauseous under the new protocol — up and moving and receiving oral nutrition as quickly as possible.

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