Improving Outcomes in Future Postoperative Ileus Cases

Raoul Concepcion, MD: This has been an extremely informative discussion. Before we end, I’d like to receive closing comments from each of our panelists. Traci, we’re going to let you lead this off.

Traci Hedrick, MD, MS, FACS, FACRS: I would just like to thank you. Always, in these types of situations, I learn something new. I think in the next 5 to 10 years, enhanced recovery is certainly going to be the gold standard of care, no matter what type of surgery you are having. I think the important thing to consider if you are a hospital, an administrator, or a surgeon trying to implement this, is that it really needs to be concerted effort. You need to listen to all of those involved, so that each person feels like they’ve contributed to the protocol. If so, they are going to be much more likely to follow it. And then, with that, there needs to be a close follow up of compliance and frequent monitoring of the outcomes.

Raoul Concepcion, MD: Great. Thank you. Sanjay?

Sanjay Patel, MD: Well, I think a big thing to consider is there’s no “I” in team. It’s not just a surgeon or an anesthesiologist. It’s a whole group of health care providers, not just physicians. The surgeons, the anesthesiologists, pain specialists, nurses, the patients, physical therapists, and nutritionists really all have to come together.

And, when you’re trying to develop a protocol at your institution, if you don’t have one already, you’ve first got to get everybody in the room. You’ve got to talk about it. You can talk about it all you want, but once you get something on paper or something formalized, then it will really come into fruition. And after that happens, you should revisit it periodically. You should check up on things every 6 months, 3 months, or whatever you think to fine tune it and make adjustments. No 2 institutions are the same. You can’t get everything the same way. There’s no cookie-cutter aspect to this. And so, I think those are important things to consider.

Raoul Concepcion, MD: Declan?

Declan Fleming, MD: I think that there are so many components to ERAS (enhanced recovery after surgery) that can be implemented. You have to look at your institution and decide, “What can we do?” It might not be that each hospital or each group can do absolutely every one of the literally dozens of potential interventions. You have to look at what’s possible. Every one of these things has the potential to really contribute positively to patient outcomes. And one other thing, I can’t emphasize enough how important it is to make the patient feel like this is not something that is being done to him or to her, but is something that they’re participating in. They really have the ability to influence their outcome by embracing this. A lot of this is about understanding that maybe the best way to manage pain isn’t just to get narcotics. If people come in with the expectation that that’s not the only way to take care of things, that really helps.

Raoul Concepcion, MD: John?

John Dalton, MD: I’ll echo Traci’s comments. I appreciate the chance to be here, in this discussion. I always learn a lot from these discussions. I think the exciting thing about this ERAS discussion is that the conversation is going toward person-centered care. We had patient-centered care not too long ago. Nobody wants to be a patient, so let’s center the care around the person. We’re coming out of an era where it’s system-centered and anything but the person. So, this is exciting to me. I think ERAS is an articulation of evidence-based best practices centered around the person. To Declan’s comment earlier, this should be expected recovery, not enhanced recovery. So, I think we need to apply it to all of our patients, going forward, as best we can. Our care should be varied based on the person’s history, not the fact that we train at different places. It is different every place we implement it, but the principle should be the same. We should drive that direction.

Raoul Concepcion, MD: Those are all fantastic comments. Thanks for all of your contributions to this discussion. I think it’s been great. It’s been a meaningful discussion, especially because of the fact that we’ve got, again, multiple specialties represented here. On behalf of our panel, we thank you for joining us, and we hope you found this Peer Exchange^® discussion to be useful and informative. Thanks so much.

Transcript edited for clarity.