The Straits Times (25 September 2019)
Scheme has led to savings, shorter hospital stays, fewer severe complications for patients
Ms Michelle Tan was hoping for a quick recovery after keyhole surgery in January to remove a tumour in her colon.
But little did she expect to walk out of the hospital the next day – three days earlier than the average colorectal surgery patient.
Ms Tan’s speedy recovery was due in part to a programme at Tan Tock Seng Hospital (TTSH) that optimises patients’ post-surgery recovery.
Since 2016, the Enhanced Recovery After Surgery (Eras) programme has led to savings of $2,197 on average for each of the more than 700 colorectal surgery patients, and almost halved the average length of hospital stays from 10.6 days in 2015 to 5.8 days this year.
It has also reduced the proportion of patients who have severe complications post-surgery, from 5.42 per cent in 2015 to 2.8 per cent this year. The proportion of patients who are re-admitted within a month has also gone down, from 10.26 per cent in 2015 to 6.8 per cent this year.
Most of those who benefited had undergone colorectal surgery, with the remaining patients from specialities such as upper-gastro intestinal, liver, pancreas and urology.
The programme involves steps that aim to reduce patients’ stress before the operation and promote their well-being thereafter, said Dr How Kwang Yeong, a consultant in TTSH’s Colorectal Service.
For example, patients no longer need to have bowel preparation or fast from midnight before surgery, and need only take clear fluids or a carbohydrate drink two hours before.
After the operation, doctors remove nasogastric tubes and drains – used to remove excess fluid or gas in the stomach – and a few hours later, patients are encouraged to sit, walk, eat and drink, instead of resting in bed for days or fasting until their bowel functions return to normal.
Ms Tan, 49, an administrative clerk, was asked to take nutritional supplements, have a good diet and maintain an active lifestyle.
“I was quite surprised that I didn’t feel much pain after the surgery and could eat, and didn’t feel like vomiting,” she said. “Four hours after surgery, I was able to get out of bed and walk.”
Still, some patients, especially the elderly, are resistant to the programme as they think that they should only stay in bed after surgery, said Dr How. “Sometimes, we have to be a little bit more firm with them, to get them out of bed first and take a few steps to gain confidence.”
The programme will be expanded at the end of the year to other forms of surgery, such as breast, ear, nose and throat, as well as knee replacement operations.
Last year, TTSH also started targeted interventions for frail patients older than 65 who are undergoing major surgery. They go through a four-week structured exercise programme to enhance their functional capacity before surgery and improve their tolerance to surgery stress. They also go through more intensive rehabilitation after surgery.