Many patients recovering faster
and with fewer complications
as hospitals adopt new protocols
Madam Cheng, 95, with (from left) TTSH’s senior dietitian Ong Yawei;
nurse clinician Kitty Ho;
Dr Jonathan Tan, senior consultant for the
department of anaesthesiology and head of the surgical
intensive care unit;
and Dr Fong Sau Shung, consultant for the department of general surgery
and
colorectal surgery service. ST PHOTO: ONG WEE JIN
The Straits Times (10 September 2016) - When Madam Cheng Hui Hoang
went for surgery to remove a cancerous
tumour in her colon last
month, she did not have to fast, nor
was she forced to stay in bed after
the operation.
Today, the 95-year-old is back on
her feet – and it is no coincidence.
Scores of patients in Singapore
have been recovering quicker and
facing fewer complications after
surgery because some hospitals
have done away with traditional
ways of managing patients.
Instead, a new set of clinical protocols
hasbeen put in place at hospitals
such as Tan Tock Seng Hospital
(TTSH), National University Hospital
(NUH) and Changi General Hospital
in recent years. It has been
tried on colorectal patients to start
with and after encouraging results,
there are plans to widen the protocols
to other disciplines.
The system, called Enhanced Recovery
After Surgery (Eras), is
based on scientific evidence which
showed that fasting and bed rest
before and after surgery, for example,
could hamper recovery, instead
of helping it.
Madam Cheng could continue taking
liquids and two hours before the
procedure, she was given a special
drink to regulate her sugar level.
When she woke up after the
three-hour operation, she was encouraged
to move around.
Under the old system, she would
have had to avoid food and drinks
from midnight before her surgery,
and remain bed-bound for several
days after.
But scientists found that fasting
before surgery could cause anxiety
in patients and contribute to insulin
resistance. This could raise risks
of complications after surgery.
Staying bed-bound post-surgery
could weaken muscles, said Dr
Doris Ng of TTSH’s gastroenterology
and hepatology department at a
media briefing yesterday.
At TTSH, where Madam Cheng
was treated, the new system started
in April has shown good results.
A study of 78 colorectal surgery
patients treated using Eras and 298
treated under traditional protocols
found that the average length of
stay dropped from 10.6 to 7.9 days
with the new system.
The percentage of patients suffering
surgical complication has also
more than halved from 17.1 to 7.7
per cent. The rate of re-admission
has also been reduced from 8.1 per
cent to 1.3 per cent.
TTSH estimates that it could
result in $2,268,000 in cost savings
for colorectal surgery patients
every year, using patients’ fees for
Aclass.
“Because we have a shorter
length of stay, the faster turnover
enables us to provide care for more
patients,” said Dr How Kwang
Yeong, a consultant at TTSH’s department
of general surgery.
“Against the backdrop of an ageing
population and a lack of beds,
Eras is going to be a game changer
in the healthcare scene,” he said.
Nextyear, the system will beintroduced
to other operations, such as
those involving stomach and liver.
At NUH, where the system was introduced
in January last year, improvements
in post-surgery complication
rates and re-admission rates
amongsome 360 colorectal surgery
patients have also been reported,
said Dr Cheong Wai Kit, head of
NUH’s colorectal surgery division.
The system has been introduced
to obstetrics and gynaecology surgery
at NUH, and there are plans to
introduce it to other disciplines such
as urology and orthopaedic as well.
How they compare
| Traditional care |
Eras system |
Before surgery
Fast from midnight. |
Before surgery
Carbohydrate drink given two
hours before procedure. |
After surgery
Complete rest in bed for days.
Not allowed to eat or drink until
patient passes gas or motion. |
After surgery
Situp and walk after a few hours.
Can eat and drink. |
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Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
