Focus on What MatterPatients Learn How to Accelerate Patient Recovery during the COVID-19 Pandemic

Good recovery is crucial to the success of the operation. Developments in smart medicine and telemedicine have accelerated during the COVID-19 pandemic but they cannot fully replace surgical treatment. A key challenge for surgical care is the implementation of Enhanced Recovery After Surgery (ERAS) during the pandemic. The International Enhanced Recovery After Surgery Expert Forum, hosted by Taipei Medical University Hospital (TMUH) and the Taiwan ERAS Society on December 18 of 2022, brought together medical experts from around the world to share their experiences of implementing ERAS during the pandemic. Through sharing and learning, the Forum aims to improve the resilience and medical quality of healthcare facilities in responding to large-scale emerging infectious diseases.

Po-Li Wei, Vice Superintendent of TMUH, said that in recent years, medical institutions at home and abroad have focused not only on the results of patients' operations but also on the speed of their recovery after surgery. The Ministry of Health and Welfare has also included ERAS in the national targets for medical quality and patient safety in hospitals for 2022-2023. With evidence-based best strategies applied by interdisciplinary teams, the integration of care in surgical anesthesia will improve medical quality and surgical safety.

Weu Wang, Vice Superintendent of TMUH, indicated that TMUH began implementing ERAS in November 2016, which has not only reduced the number of days patients spend in the hospital after surgery, but also significantly reduced the number of unplanned returns to the operating room and emergency visits within three days of discharge. The recent global pandemic has created new challenges for the medical industry, and the forum has specifically invited Prof. Hans D. de Boer, President of the International ERAS Society, and Dr Kwang Yeong How from the Department of Colorectal Surgery at Tan Tock Seng Hospital in Singapore to share their experiences in promoting ERAS during the pandemic.

Prevent Pandemics from Affecting Patient Care through Continued Implementation of Eras

During the COVID-19 pandemic, ERAS measures were not implemented and surgical schedules were adjusted, leading to possible delays in diagnosis and treatment, and according to the literature, these delays in the diagnosis and treatment of cancer during the pandemic led to an increase in mortality. To this end, both invited speakers, Prof. Hans and Dr. How, agreed that by establishing ERAS guidelines for COVID-19-positive patients and implementing evidence-based care interventions with the help of information technology, low surgical complications can be effectively maintained to ensure patient safety and medical quality, while also reducing the workload for surgery. Hospitals can draw on this experience to help make the organization resilient and ready to respond to future emerging infectious diseases.

Meanwhile, Dr. Yan-Jiun Huang, Director of the Department of Colorectal Surgery at TMUH, responded that as the incidence and mortality of colorectal cancer in Asian countries increases year by year, a survey of colorectal cancer patients over the age of 65 during the pandemic showed that the implementation of ERAS had a significant positive impact on the quality of life after surgery, such as reducing the number of days with abdominal distension by 11%, allowing patients to eat soft foods 50% sooner, and effectively shortening the average length of hospital stay by 2 days.

Let the Data Speak for Itself and Get Patients Involved in ERAS

TMUH also applies ERAS to patients with morbid obesity. Dr. Wayne Hsu, Director of the Weight Management Center at TMUH, revealed that analysis of the database of morbidly obese patients undergoing weight loss surgery showed that the incidence of complications was 0.3%, the rate of return visits to the emergency department within three days of discharge was 0.6%, and the 30-day mortality rate was 0% after the introduction of ERAS. These outcomes are better than international standards. Therefore, under the principle of patient-centered care, ERAS can effectively reduce the risk of surgical complications and death.

In addition, Dr. Hsi-Wen Liao from the Department of Anesthesia & Pain Medicine at TMUH used the BI in-hospital data visualization dashboard to cross-analyze ERAS implementation with hospital-wide surgical monitoring indicators, such as anesthesia-related items including preoperative antibiotic use and intraoperative multimodal analgesia and antiemetics, and found a significant correlation between preoperative antibiotic use and postoperative complications. By using precision anesthesia and rapid recovery medications, patients can quickly and safely regain consciousness and muscle strength after surgery, reducing the risk of postoperative complications such as excessive vomiting. This can be used as a reference for preoperative anesthetic counseling and physician-patient shared decision-making to reduce patient anxiety before surgery.