The University Hospital of Gran Canaria Doctor Negrín has been part, since last November, of the Plan for the Implementation of Intensive Recovery in Adult Surgery (Imprica). This is a national program that allows patients who have undergone abdominal surgery to shorten the time of hospital admission and reduce the risk of possible complications. The truth is that since May 2017, the northern hospital has applied Fast-Track surgery – rapid recovery – to treat tumors of the colon and rectum, a technique that already goes hand in hand with this national initiative, and that has proven its effectiveness in manage to induce an earlier recovery. “We are facing a new surgical approach that aims for the patient to remain admitted as shortly as possible in the center. In fact, the usual thing is a minimum stay that ranges between 7 and 10 days, while with this type of surgery, we reduce it to three or four, “says Dr. Eva Nogués, coordinator of the Coloproctology group of the General Surgery Service of the hospital.
It should be noted that it is minimally invasive surgery -laparoscopic or robotic-, which is applied in these cases. However, as the doctor warns, the patient’s commitment is “fundamental” so that it can be included in the program, since four or five weeks prior to the intervention, a series of guidelines must be followed. “A group of rehabilitators has to evaluate the patient to know their physical condition and lung capacity. From there, an exercise program is established that can be practiced in the hospital or at home, depending on each case,” notes the healthcare professional.
Also, another of the peculiarities presented by this practice is that patients should consume a low-residue diet seven days before the intervention. In addition, it is recommended that you drink carbohydrate-rich smoothies up to two hours before entering the operating room. “It has been scientifically proven that these measures have a very positive impact on this group of patients,” says the specialist of the hospital Grancanario. To this we must add the work of the anesthetist, it is very important that you avoid using substances derived from morphine, because they are prone to cause nausea and vomiting to patients. “Once in the operating room, the professional uses very short-acting anesthetics so that the subject can wake up quickly,” adds Dr. Nogués.
Finally, early mobilization also takes a leading role in this program. And it is that the patient must join the same day of the intervention and proceed to walk when 24 hours have elapsed “Our experience has allowed us to verify that they can get up and tolerate fluids quickly. Three days later, they can start following a diet more pasty, “adds the doctor. But this is not all. When the patient is discharged, a nurse from the group will be in charge of conducting a telephone follow-up to assess that the recovery process continues an adequate trajectory. Also, it is essential to go to a medical review when 15 days have elapsed. Based on the words of the specialist, this kind of surgical procedure is indicated for people between the ages of 18 and 85. However, emergency surgeries are excluded from this practice, as well as morbidly obese patients – with a body mass index greater than 40 – and those who are not in full use of their mental faculties.
So far, the Negrin has intervened about thirty people through this technique. “Ideally, we could include all patients in the program, but we are limited because the rehabilitation service cannot assume more than one patient a week,” laments the expert. According to Dr. Nogués, Negrín professionals are very satisfied with this initiative, not only because of the advantages it presents for patients, but also because they are extrapolated to the healthcare system. “By being able to shorten the time of entry, the associated costs are also reduced. This makes it consolidated as another of its multiple benefits,” he says. To later advance that, one of the purposes that the hospital complex is marked is to be able to extend the technique “to urology and to the digestive tract”. Imprica is a project developed by the Spanish Multimodal Rehabilitation Group, in which the steps to be followed for the implementation of the Intensive Recovery Clinical Pathway in Adult Surgery (RICA) in the country are specified. The initiative aims to create centers of excellence in recovery nationwide.