Enhanced Recovery After Surgery
The pathway to achieving optimal recovery from surgery and satisfactory results starts way before the day of surgery. No one runs a marathon without preparing for it several months before. In a similar manner, a patient should prepare his/her body to successfully undergo surgery.
Recovery after surgery is a journey, and although it looks different for every patient, there is one thing in common: we all want the shortest, most comfortable recovery possible.
Many patients are apprehensive about what comes after surgery. Whether it’s your first procedure or your fifth, it’s normal to have questions and concerns about this part of the process. The truth is that any surgery — cosmetic or reconstructive, minor or significant — puts stress on the body. Having a positive recovery experience requires close collaboration between the patient, the surgeon and other members of the care team.
Our top priority is that you feel safe and comfortable through every step of your experience with us. With this mission in mind, Dr. Wiser and his team have adopted industry-leading recovery protocols designed to return our patients to full health as quickly as possible, with less pain, fewer complications, and better scarring. These protocols are known as Enhanced Recovery After Surgery, or ERAS®. Implementing ERAS® recommendations before, during and after surgery helps ensure that all patients receive the highest quality of care at WiserMD.
What Is Enhanced Recovery After Surgery?
ERAS® is a patient-centered, evidence-based treatment program designed to achieve early recovery for patients undergoing surgery. The protocol items are developed by medical professionals across multiple disciplines, including surgeons, nurses, anesthesiologists, dieticians, physical therapists and others. These professionals jointly monitor the latest research and best practice standards, and continuously update ERAS® guidelines to optimize patient outcomes.
ERAS® is a collection of complementary practices (or “pathways”) that work together to make recovery faster, easier and healthier. These practices are all about you — the patient — and making sure your surgical experience is the best it can be. Medical providers around the world are implementing ERAS® protocols to improve quality of care and increase patient satisfaction.
To enhance your recovery from surgery, you need to play an active role in your own care. You and your surgical team will work together to get you back to full health as quickly as possible.
ERAS® PROTOCOLS BEFORE SURGERY
Enhanced recovery begins long before a surgical procedure takes place. The better physical and mental shape you’re in before surgery, the easier and faster your recovery will be. Dr. Wiser uses ERAS® guidelines to provide patients with the knowledge and tools they need to reach their healthiest state before surgery. Before the day of the procedure, Dr. Wiser and his team will talk to you about your role in the enhanced recovery pathway and give you important details about how to prepare your body for surgery. This includes protocols regarding:
Mental and Emotional Preparation
Psychological stress can have a substantial impact on your body’s ability to heal. Although it’s important not to downplay the significance of surgery, too much fear or distress before surgery is linked to a slower and more complicated recovery. A critical part of the preparation before surgery includes our team educating you about what you can expect as a patient. The more you know about what lies ahead, the better you are able to prepare and make informed decisions, and the less stress you are likely to feel.
Most of us are now familiar with the dangers of smoking. The risks are even more severe in the periods before and after surgery. Smoking before surgery or during your recovery presents a number of serious repercussions, including impaired wound healing and increased risk of infection, blood clots, heart attack and pneumonia. Former smokers also have increased risk for complications after surgery. The minimum smoking-free time required to be eligible for surgery at WiserMD is four weeks. Each patient undergoes a nicotine test prior to surgery to validate their non-smoking status. If you need help stopping, talk to our team about smoking cessation programs and medicines that can increase your chances of quitting for good.
Your diet provides the minerals, vitamins and amino acids your body will need to heal after surgery. It is imperative to focus on healthy, balanced nutrition and address any deficiencies that may impair your surgical results. Before your procedure, we will conduct a nutritional status assessment to identify nutrient deficiencies and create a plan to address them. This may involve changing the foods in your diet as well as taking appropriate supplements.
Some of the nutrients the play key roles in surgical recovery include:
Iron: low iron may lead to a lack of adequate healthy red blood cells (anemia)
Vitamin C: vitamin C is involved in immune function and all phases of wound healing
Vitamin D: vitamin D deficiency can adversely affect wound healing
Protein: protein provides the building blocks to build, maintain and repair body tissues
Omega-3 fatty acids: omega-3 fatty acids reduce inflammation and support healthy immune response
Amino acids: amino acids like glutamine and arginine help offset the physical stress of surgery and accelerate the recovery process
Your preop plan might also involve immunonutrition — formulas containing DHA omega-3 fatty acids and other specific ingredients to inhibit inflammation, improve immune function and support tissue repair — or isotonic drinks to keep your nutrient and hydration levels high.
Alcohol and anesthesia do not mix. The list of complications that can come with alcohol consumption close to surgery ranges from compromised immune function, to excessive bleeding, to delayed wound healing. It’s important to take a break from alcohol before your procedure for a healthy recovery and the best possible outcome. The longer you can refrain from drinking before surgery, the better.
A surgical site infection (SSI) is an infection that can develop during or after an operation. Some SSIs only involve superficial layers of the skin, while others are more serious – they can involve deeper tissues, organs or implanted material. Bathing with antibacterial soap for several days before surgery and after surgery can decrease the risk of infection. At WiserMD, we provide a special soap that includes chlorhexidine, a fast-acting and long-lasting ingredient that is proven to reduce post-surgical infections.
ERAS® PROTOCOLS DURING SURGERY
During surgery, the ERAS® guidelines focus on multi-modal approach to pain management and the treatment of postoperative nausea and vomiting. Your first dose of medicines to treat these concerns will be administered prior to the start of surgery. During the procedure, you will be watched over by a team of specialists who will monitor your state to ensure you remain safe and comfortable.
Nausea and vomiting after surgery are known risks of anesthesia. Feeling nauseous after surgery is uncomfortable and can dramatically slow your return to normal activities like eating and drinking. Vomiting after surgery can be quite painful and can put stress on some surgical incisions. To mitigate these effects, we will administer anti-nausea medication prior to surgery and again through an IV during the procedure.
With any type of surgical procedure, you will experience some discomfort or pain. ERAS® care plans are designed to minimize negative side effects associated with commonly used pain medications so you can return to your regular activities as soon as possible. Your personalized pain management plan may include different types of medications that act together synergistically, such as a regional nerve block that numbs a specific area of the body using a long-acting anesthetic called Exparel® that can numb the surgical area for up to 72 hours. After the procedure, Dr. Wiser prescribes a pain-controlling medication named gabapentin that increases pain tolerance and improves recovery.
ERAS® protocols dictate that some pain medication should be started prior to surgery. Doing this helps blunt your body’s initial response to pain, so that you require less anesthesia and fewer to no narcotics use after surgery.
Scarring is part of any surgical procedure. Although there is no way to prevent the formation of post-surgical scars, a skilled surgeon like Dr. Wiser can utilize advanced techniques and strategic incision placement to minimize the size, severity and visibility of your scars. Dr. Wiser will use the smallest and least conspicuous incisions possible for the improvements you desire. His choice of sutures and surgical technique will also be guided by the goal of maintaining balance between achieving your desired outcome and minimizing scarring.
ERAS® PROTOCOLS AFTER SURGERY
After your surgery, you will go to a recovery room where members of your WiserMD care team will monitor your vital signs as you wake from anesthesia. They will also give you any medicines you need and update your caregivers on how you are doing. It is important to get out of bed, sit in a chair and walk as soon as you are ready. Do this as often as you can. Your team will tell you when it is safe for you to start drinking, eat solid food, move without assistance and go home. Enhanced recovery protocols during the postoperative stage include:
Research shows that starting a regular diet within the first few hours after surgery improves wound healing and lowers the infection rate. Fill your diet with nutrient-rich whole foods containing lean protein, antioxidants, vitamins, healthy carbohydrates and fats, probiotics and fiber. These nutrients prepare your body to face many of the challenges it may encounter while you heal. Limit your intake of added sugars, dairy products, highly processed foods and alcohol, which can worsen common post-surgical complications like constipation and inflammation.
One of the easiest overlooked, but most important, things needed after surgery is water. Dehydration is common following surgery and maintaining adequate levels of hydration will help you feel better and recover quicker. Drinking plenty of water can also help reduce postop nausea, prevent constipation and stimulate your appetite. Isotonic drinks can help you meet your hydration needs if plain water is unappealing or insufficient.
The combination of reducing nausea, pain and constipation with ERAS® protocols can allow for you to start eating and moving sooner. Early walking after surgery is one of the most critical things you can do to minimize problems. Walking promotes the flow of blood and oxygen through your body and maintains normal breathing function. It also strengthens your muscle tone and speeds wound healing. Failure to get moving may cause increased pain, constipation and weakness, and puts you at a greater risk for infections, blood clots in your veins (deep vein thrombosis) or lungs (pulmonary embolism), and pneumonia.
Dr. Wiser will prescribe appropriate medications to help you manage pain, inflammation and nausea after your surgery. These medications should be taken as prescribed and may be supplemented with over-the-counter medications. By using the long-lasting anesthetic Exparel® during surgery and prescribing the right combination of medications after surgery, Dr. Wiser limits the amount of narcotic pain medication patients need. This approach reduces nausea and vomiting, allows patients to walk earlier and minimizes the disruptions surgery can have on daily life.
The lymph system is your body’s natural cleansing mechanism. A healthy lymphatic system is essential for your body’s ability to drain fluids, detoxify, remove waste, regenerate tissues and maintain a strong immune system. Long, rhythmic strokes are used to mobilize the body's fluids and encourage the elimination of waste and fluid. After surgery, these techniques can be helpful in the reduction of swelling and pain, making your recovery faster and more comfortable. Lymphatic massages are typically recommended after body procedures, such as liposuction, abdominoplasty and arm or thigh lifts. At WiserMD, we recommend weekly professional lymphatic massages after surgery to reduce swelling and improve outcomes.
In addition to the scar minimization techniques Dr. Wiser will use during your surgery, you will be advised of ways you can improve your scars at home. A member of the WiserMD team will provide you with detailed instructions for washing and dressing your healing incisions, minimizing tension on your incision lines and softening your scar with massage. Silicone gel, sheets or ointments can be used for several months to improve a scar’s appearance.
Dr. Wiser also recommends patients use the PREVENA™ Incision Management System. This unique technology helps hold incision edges together, removes fluid and infection materials, and protects the incision from contamination. The PREVENA™ system is lightweight and portable, and should be worn for the full period Dr. Wiser instructs.
The Benefits of Enhanced Recovery Protocols
ERAS® programs have been shown to be safer and more effective than traditional recovery care. Implementation of these protocols is associated with numerous benefits, including:
Shorter length of hospital or surgery center stay
Decreased postoperative nausea, vomiting and pain
Decreased reliance on narcotic pain medication
Lower complication and readmission rates
More rapid return of bowel function
Accelerated return of organ and musculoskeletal function
Earlier resumption of normal activities
Reduced fatigue and need for daytime sleep
Reduced number of days patients require off work
Learn More About How We’re Making Surgery Better, Safer and More Accessible
The human body is complex, but it is also remarkable — if we provide it with the best care before, during and after surgery, we can achieve better aesthetic results and improve the quality of life for our patients. Dr. Wiser has personally observed the positive effects ERAS® protocols have on the recovery process. Since incorporating these recommendations into his practice, he has witnessed patients recover faster, with less pain and fewer side effects, and return to their lives sooner.
For more information about how we approach recovery after plastic surgery, please don’t hesitate to contact us. We’d love to speak with you about our process and answer any questions you may have.