Strategies for achieving enhanced recovery of patients after gynecological surgery were explained at the latest Weill Cornell Medicine-Qatar (WCM-Q) Grand Rounds by one of the college’s former students.
WCM-Q graduate and Qatari national Dr Aisha Ahmad AA Yousuf, now Medical Director of Reproductive Surgery at Sidra Medicine, returned to the college to explain the concept of Enhanced Recovery After Surgery (ERAS), the advantages it offers patients, and its current therapeutic limitations, before an audience of physicians, pharmacists, nurses and allied health professionals.
Dr Yousuf, a member of the first WCM-Q graduating class in 2008, said the goals of ERAS are to attenuate the surgical stress response, reduce the length of hospital stay, speed up the patient’s return to normal daily activities, and improve outcomes without increasing the rate of complications, re-admissions or costs.
I think of surgery as a marathon for the patient: you must prepare them carefully beforehand, manage the stresses on the body during the procedure, and then follow a recovery process afterwards in order to achieve the best results.’
After graduating from WCM-Q, Dr Yousuf completed her obstetrics and gynaecology residency programme at the University of Michigan Hospital in the US. She then completed a fellowship in minimally invasive gynaecologic surgery and pelvic floor reconstruction at St Michael’s Hospital, University of Toronto.
Dr Yousuf said that ERAS requires a multi-disciplinary approach involving active participation of patients, surgeons, anaesthesiologists, pain specialists, nursing staff, physical and occupational therapists, and social workers. She explained the importance of pre-admission information, education and counselling to give patients accurate expectations about the surgical and anaesthetic procedures, and to ensure that pre-operative instructions, such as fasting and taking medications, are followed correctly.
Advances in technology, according to Dr Yousuf, allowed for minimally invasive surgery, which uses very small or keyhole incisions and robotic surgical tools, and had dramatically enhanced recovery outcomes. Post-operation, incidence of nausea and vomiting – common after gynaecological surgery – can be reduced by increased utilisation of regional anaesthesia and decreasing or eliminating use of opioid-based pain medications.
Providing compression stockings and prophylaxis to reduce the risk of post-operative thrombosis also enhances recovery outcomes, as does early mobilisation of the patient and early intake of food and fluids, both of which should occur within 24 hours of the surgery.
The lecture titled Enhanced Recovery in Surgery in Gynecology, was accredited locally by Qatar Council for Healthcare Practitioners-Accreditation Department (QCHP-AD) and by the Accreditation Council for Continuing Medical Education (ACCME). For updates and more information about WCM-Q, visit their website at qatar-weill.cornell.edu.