If you’ve had surgery, you know how important rehabilitation is to recovery. Working with a physical therapist, occupational therapist, and other rehabilitation specialists helps you regain your strength and returns you to your normal activities faster. Traditionally, rehabilitation begins after surgery.

The team at Dignity Health Yavapai Regional Medical Center (YRMC) is part of a movement by leading health care organizations to introduce what could be named “prehabilitation.”

Enhanced Recovery After Surgery (ERAS®), as it’s actually called, is designed to get you ready for your post-surgery recovery program before you even see the inside of a surgical suite.

“ERAS is a way to help people prepare physically and mentally for their postoperative course,” says Pierre Tibi, MD, FACS, Director, the James Family Heart Center at Dignity Health YRMC and a cardiothoracic surgeon. “It’s a partnership that involves patients and every YRMC team member who comes in contact with them as part of their surgery.”

That multi-disciplinary team – physicians, nurses, dietitians, pharmacists, rehabilitation specialists, and more – puts into action ERAS protocols that are scientifically proven to curb complications, reduce hospital stays, and accelerate recovery. Education and communication are threads that connect ERAS protocols at every phase.

“Patients are at the center of ERAS,” Dr. Tibi says. “They are provided complete information about what to expect during their surgical journey. This empowers people to take an active role in their recovery.”

Why is YRMC implementing ERAS? The answer is related to metrics and mission. Data from numerous large studies show ERAS programs:

  • Reduce complications by 50 percent
  • Shorten hospital stays by 30 to 50 percent
  • Improve patient satisfaction

“Beyond the data, ERAS demonstrates YRMC’s commitment to ensuring patients have the best experience we can give them during a stressful time,” says Kenneth O’Beirne, MD, a YRMC-affiliated anesthesiologist. “We’re applying the top medical science available and evidence-based practices to improve their care. To me, that shows we take our role as health care providers very seriously.”

The ERAS journey
ERAS begins as patients are contemplating surgery and continues through recovery. The protocols – developed by the non-profit ERAS Society – focus on improving the delivery of health care for surgical patients throughout the care cycle. This includes a surgery-specific roadmap that covers many phases, all of which involve patients in their recovery.

Operation get ready for surgery
Before surgery, YRMC clinicians help patients prepare using ERAS strategies that improve nutrition and physical fitness. They also share information on what patients can expect at every phase of their specific operation.

“The more patients understand about their surgery, the more they can participate in their healing,” says Olivia Marsh, RN, Nurse Manager, Pre-Admission Testing, Pre-Op, and Post-Anesthesia Care Unit. “During the pre-operative phase of ERAS, we speak to patients about their expectations after surgery. We also discuss pain, which is part of the healing process.”

For example, YRMC nurses coach patients undergoing knee replacement surgery to prepare by walking five times a day, even if it’s making loops around their living room. Studies confirm that being active prior to surgery reduces pain following the operation.

In addition to engaging in exercise, patients receive information and tools to, for example:

  • Eat a healthy balanced diet
  • Stop smoking or consuming alcohol/drugs
  • Manage blood sugar levels

What happens during surgery helps with recovery
The surgeon and anesthesiologist collaborate during surgery to reduce the physical stress of the operation on the patient. Fluid management is a good example of ERAS protocols at work in the operating room. Typically, patients receive fluids during surgery to manage their blood pressure. The problem is too much fluid can lead to excessive water weight, which can delay recovery. ERAS protocols call for careful fluid management.

During surgery, anesthesiologists combine different types of medications as part of the ERAS protocol. Anesthetic drugs, nerve blocks, and anesthesia that targets specific parts of the body may replace conventional anesthesia.

Let the healing continue
After surgery, patients are encouraged to both eat and walk sooner. Research shows that the quicker food is re-introduced, the less need there is for intravenous medications and fluids. Additionally, walking reduces muscle loss, improves the respiratory function, and lowers the risk for pneumonia.

“Patients also get a psychological boost when they’re up and moving following surgery,” Dr. O’Beirne says. “They think, ‘I can do this.’”

Opioids are not part of the ERAS pain management protocol. Instead, combinations of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), injections of local anesthetics at the incision, and peripheral nerve blocks help ease pain.

A patient-provider partnership
How has the patient-provider dynamic evolved thanks to ERAS?

“Safe and successful surgeries have always been the goal of our team,” Marsh says. “What’s changed is that ERAS challenges us to look at every aspect of the surgical journey from our patients’ perspective. That’s driving us to adopt strategies that involve patients as our partners in new ways that benefit all of us.”