As many patients are worried about getting general anesthesia, National Taiwan University Hospital (NTUH) yesterday said it has introduced a Enhanced Recovery After Surgery (ERAS) multimodal perioperative care pathway for more vulnerable patients undergoing major surgery to improve their recovery, leading to fewer complications and shorter hospital stays.
NTUH superintendent Wu Ming-shiang (吳明賢) said that National Health Insurance data show that more than 2.4 million cases of general anesthesia were performed in 2021, equivalent to about one-10th of the population.
NTUH Department of Anesthesiology director Yeh Yu-chang (葉育彰) said many patients who need surgery with general anesthesia are worried about waking up during surgery, never waking up, feeling severe pain after surgery and other health risks, with some even unwilling to undergo surgery because they fear anesthesia.
Photo: CNA
While patients often hold fear and misconceptions about general anesthesia, healthcare providers are often concerned about how to keep patients safer during surgery and allow them to recover faster, Wu said, adding that shared decisionmaking and ERAS can come into play to ease their concerns.
ERAS Society Taiwan Chapter chairman Guo Shu-lin (郭書麟) said ERAS is a patient-centered approach that has an evidence-based multidisciplinary medical team helping vulnerable patients move from home through the prehospital, preoperative, intraoperative and postoperative phases of surgery, and then returning home with more preparation, reduced stress and better outcomes.
When patients engage in shared decisionmaking to understand the surgery procedure in advance, they are less afraid and more compliant, allowing the medical team to also feel less stressed while they try to optimize the patient’s physiological condition for surgery, he said.
Guo said the medical team also precisely monitors and adjusts the general anesthesia during surgery to keep patients safe and comfortable, and implements a multifaceted approach to reduce a patient’s postoperative complications and shorten their stay in hospital, allowing them to return home earlier.
NTUH Department of Anesthesiology attending physician Liu Chih-min (劉治民) said the hospital admits many patients with acute, critical and rare illnesses, or other vulnerable or elderly patients, who are usually at higher risk of postoperative complications from general anesthesia, including respiratory failure, muscle weakness, nausea, vomiting, pain, low body temperature and discomfort.
He said going through major surgery under general anesthesia is like preparing for a marathon, so if patients can be assisted by a team to optimize their mental preparedness and physiological condition through physical training and adjusted diet at home in the two weeks before surgery, the outcome is often better.
The ERAS care service includes healthcare professionals from the departments of anesthesiology, surgery, internal medicine, rehabilitation, nursing and nutrition, as well as the quality management center and a case manager, providing customized care from the prehospital to postoperative phases.
NTUH has about 100 patients undergoing the ERAS care pathway each year, and as the hospital admits many vulnerable patients, such as elderly patients with sarcopenia (loss of muscle mass and strength), the capacity is expected to gradually expand in the coming years, Liu said, adding that previous cases have shown it can reduce the time spent in hospital by at least 10 percent, and about 60 percent of the care services are covered by the National Health Insurance system.
Ministry of Health and Welfare Department of Medical Affairs Director-General Liu Yueh-ping (劉越萍) said surgical safety is an objective in the annual National Patient Safety Goals and studies have shown that ERAS reduces postoperative complications by about 50 percent.
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