Colorectal Surgery Patients Following New ‘Rules’ with Less Pain and Shorter Hospital Stays

Patients in need of colorectal surgery at MedStar Georgetown University Hospital now have the opportunity to participate in the Early Recover After Surgery or ERAS protocol that goes against what we usually think about rules and surgery.

June 5, 2015

(Washington, D.C) - Patients in need of colorectal surgery at MedStar Georgetown University Hospital now have the opportunity to participate in a protocol that goes against what we usually think about rules and surgery.

“We have been telling patients not to eat or drink after midnight the night before surgery and we have traditionally followed surgery with large doses of narcotics to control pain,” said Allen Chudzinski, MD, Site Director for the MedStar Colorectal Surgery Program at MedStar Georgetown University Hospital.  “We also used to increase their intravenous fluids and we required patients to stay in bed for several days to recover after surgery. We now know those practices are not beneficial for most patients.”

Recent studies suggest that some of the standard conventions about what patients should and should not do before and after surgery should change. 

MedStar Georgetown has begun using a protocol called Early Recovery After Surgery or ERAS, a departure from the traditional procedures surrounding surgery.

“This new pathway encourages techniques that result in patients having better pain control, fewer side effects from narcotics and the ability to go home quicker,” said Hannah Schobel, DO, in the Department of Anesthesia which began implementing the ERAS protocols in December 2014. “We encourage these patients to have a high carbohydrate drink like Gatorade two hours before their surgery because we have found that putting the body in starvation mode can prolong recovery. Many of these techniques have been used in Europe for the past two decades and patients are recovering quicker from surgery.”

When Robert Friess of Virginia had surgery to remove a large polyp in his rectum, Dr. Chudzinski used this new ERAS approach.

“Mr. Friess needed a surgery that used to require a two week hospital stay,” said Chudzinski.  “Instead of following the customary rules about surgery, he was allowed to have a sports drink two hours before his operation and we started him on non-narcotic pain medication prior to taking him into the OR instead of waiting until after. We know that narcotics can slow down the digestive tract. So if we use more targeted pain control like epidurals and give medications like acetaminophen instead of narcotics, patients get their GI function back quicker, can eat sooner and leave the hospital quicker. “

“I was home in three days and was working from home after about five days,” said Friess who enjoys playing full contact hockey. “The surgery and my recovery really weren’t that bad at all and I have approval to get out on the rink again just four weeks after major surgery. To me, that’s pretty amazing.”

One study published in the Journal of the American Medical Association last year found that the use of the ERAS protocol for colorectal surgery reduced hospital stays from 6.7 days to 3.7 days and narcotic use dropped from 63 percent to 15 percent of patients.

Other surgical departments at MedStar Georgetown are also exploring the ERAS procedures for their patients.

“In our initial look at hospital stays here at MedStar Georgetown, colorectal surgery patients are leaving in about two days rather than five to seven days. I think these ERAS techniques can be used successfully in other surgical specialties. The science and the studies are there to back it up and the patients really appreciate the change,” Chudzinski said.

About MedStar Georgetown University Hospital

MedStar Georgetown University Hospital is a not-for-profit, acute-care teaching and research hospital with 609 beds located in Northwest Washington, D.C. Founded in the Jesuit principle of cura personalis—caring for the whole person—MedStar Georgetown is committed to offering a variety of innovative diagnostic and treatment options within a trusting and compassionate environment.

MedStar Georgetown’s centers of excellence include neurosciences, transplant, cancer and gastroenterology. Along with Magnet® nurses, internationally recognized physicians, advanced research and cutting-edge technologies, MedStar Georgetown’s healthcare professionals have a reputation for medical excellence and leadership. MedStar Georgetown University Hospital—Knowledge and Compassion Focused on You.

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Marianne Worley
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