Authors (including presenting author) :
Tse YHD(1), Fung BKY(1), Lam HTK(1), Kwok SY(2), Koo CH(3)
Affiliation :
(1)Physiotherapy Department, (2)Department of Surgery, (3)Department of Anaesthesiology and Operating Theatre Services, Kwong Wah Hospital
Introduction :
Enhanced Recovery After Surgery (ERAS) is multi-disciplinary perioperative care program, focused on improving surgical outcomes by attenuating the stress response to surgery and enables a rapid complication-free recovery. An ERAS Team for colorectal surgery was established in KWH in April 2019 which involves surgeons, anesthetists, physiotherapists, nurses and dietician. Physiotherapists as one of the core members in the team play key roles in both preoperative and postoperative phase.
Objectives :
To share the physiotherapy clinical experience in ERAS program in colorectal surgical patients
Methodology :
A Pre-admission Clinic was formulated and patients with elective colorectal surgery were recruited. An education class included preoperative chest physiotherapy, home-based prehabilitation program and postoperative care pathway was delivered. Health-related quality of life (HRQOL) questionnaire (SF12) and Six-Minute Walk Test (6MWT) was used for screening of patient’s health status and functional capacity respectively. Patients with American Society of Anesthesiologists (ASA) Physical Status Classification > 2 and 6MWT distance < 340m would be alerted for reinforcement of early prehabilitation physiotherapy conditioning program. Tailored education pamphlet, incentive spirometer and elastic resistant band were prescribed to patients to enhance home-based training. In initial postoperative phase, early mobilization approach was used to enhance speedy recovery. Mobilizing patients in upright posture would be commenced on the first day after operation. Intensive postoperative chest physiotherapy, early ambulation and reconditioning program were enhanced. Modified Functional Ambulation Classification (MFAC) was documented upon discharge.
Result & Outcome :
From April 2019 to December 2022, a total of 246 patients attended pre-admission clinic in the ERAS program. There were 151 males, 95 females with mean age of 69.4 ± 10.9 years old. The average and median of length of stay (LOS) of those patients were 7.2 ± 2.4 and 7 days respectively. 68 patients had a stoma after operation required stoma care education before discharge, while the average and median LOS of those with a stoma were 8.5 ± 2.3 and 8 days respectively. For patients without stoma, the average and median LOS were 6.7 ± 2.3 and 6 days respectively, where median LOS for colorectal surgery in HA hospitals was 7 days in 2018/19. The mean of Mental Summary Score (MCS) and Physical Summary Score (PCS) are 45.7 ± 6.2 and 43.6 ± 5.2 respectively, which is within the normal range of Chinese adult in Hong Kong. Around 10% of patients were alerted for 6MWD less than 340m. For the post-operative data, more than 87% of patients achieved upright mobilization on the first day of post operation. Also, more than 90% of patients achieved independent ambulation (MFAC ≥ 6) and more than 90% was directly discharged home after surgery. There was no report for post-operative chest complications.
