By Michael Nussbaum
Nussbaum is Chair of Surgery for Carilion Clinic and the Virginia Tech Carilion School of Medicine.
The Roanoke Times recently ran an article titled “More hospitals making push to get older adults in better shape for surgery” (Feb. 7 news story). It highlighted the important work our peers in North Carolina, California and Michigan were doing to emphasize senior wellness in the weeks leading up to surgery, proactively improving patient readiness and surgical outcomes.
Great topic, but it was missing one major piece: You don’t have to travel out of state or even out of the region to get this kind of care. Groundbreaking “prehabilitation” work for all patients including older adults is happening right here in Roanoke.
Surgery can be intimidating at any age. Older populations, however, are shown to be more at risk for suffering from complications. In light of this, Carilion implemented a program five years ago to help seniors take control of their own health before they even step into the operating room.
This program has been shown to not only improve patient readiness, but also make surgical recovery easier and faster. The program is two-fold, consisting first of prehabilitation or readiness preparation for surgery. Leading up to surgery, patients are actively involved in their own education, preparation for surgery, and engaged in their own wellness.
During prehabilitation, patients attend a class to learn about things that they can do prior to surgery to help aid in recovery. They are asked to focus on things like nutrition, oral care and exercise and they are provided nutritional supplements. They are able to continue to maintain their nutrition and hydration up until just a few hours before their operation. Our experts provide tips and best practices that reduce post-operative complications, arming patients with the knowledge needed to prepare on their own in the weeks leading up to surgery.
Once the prehabilitation program is complete, patients are primed and ready for surgery, during which the second phase or what is called an enhanced recovery protocol (ERP) is enacted. ERP is a collection of evidence-based best practices in protocol format around the surgical experience. For example we focus on the prevention of post-operative nausea and we may use other pain medications in place of narcotics, using what is called multimodal pain management — things like epidurals, nerve blocks, IV Tylenol or a low-dose drip of lidocaine. As a result, patients come out of surgery less groggy, less dehydrated and less nauseated, which means they can get up and move around and eat much sooner.
Since starting in 2013, we have seen much success with this protocol for all of our patients, especially in our older adult populations. Our results have been reported at national surgical venues and widely published in the surgical literature. We have seen substantial improvements in our outcomes with reduced complications, shortened length of stay in the hospital and increased patient satisfaction.
The worst thing for a patient and his or her family is to feel helpless and disengaged. This program promotes engagement and empowerment for older adults, ultimately leading to better outcomes. Most importantly, this type of care is and has been happening right here in our community.