Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care resulting in substantial improvements in clinical outcomes and cost effectiveness. It is a multimodal and multidisciplinary approach for surgical patients. A local ERAS team was established in United Christian Hospital since 2017 and Physiotherapy (PT), as one of the core members had her key roles re-defined from pre and post-operative physiotherapy to (1) pre-operative risk stratification; (2) pre-habilitation; and (3) post-operative early mobilization for facilitation of recovery.
In pre-operative phase, PT delivers the service directly in surgery clinic where stratification of cardiac risk and empowerment for pre-operative physiotherapy are performed. Screening of cardiac risk through Functional Capacity Evaluation using Step Test enriches Anesthetist’s comprehensive pre-operative assessment. Cases with the Revised Cardiac Risk Index score > / = 2 are indicated for the test and patients achieved lower than 4 METS would be alerted for further investigation and optimization before the surgery.
Multi-disciplinary collaboration in the joint clinic not only facilitates one-stop patient service, but also enhances inter-disciplinary communication in which patients with suboptimal physical capacity are identified and recruited for pre-habilitation. This is either a home-based or out-patient conditioning program, making use of individualized and specific exercise regime to augment functional incapacitation and speed up recovery after operation.
Post-operative “Early Mobilization” defined as mobilizing out of bed at least once in the first 24 hours (D1) after operation is one of the key predictors of successful hospital discharge. With better pain management and nausea control, upright mobilization could be advanced to operative day. Mobility Cue Card facilitates inter-disciplinary communication and collaboration in ward where patients are continuously receiving rehabilitation until regaining independency in ambulation.
From 2017 to 2018, a total of 351 patients (224 male, 127 female, mean age 70.6) having colorectal surgeries are under the ERAS program. Data analysis reveals that (1) 51% of patients required Functional Capacity Evaluation Test; (2) more than 80% of patients achieved upright mobilization on D1 and (3) more than 98% of patients achieved independent ambulation and directly discharged home after surgery.
ERAS is an evidence-based care improvement process requiring collaborative team work and PT is a core member throughout the patient journey from risk stratification to rehabilitation pre- and post-surgery.
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