Doctors develop new techniques for recovery from surgery

TROY — Those recovering from surgeries may soon have an easier time thanks to a new treatment plan developed by doctors at Corewell Health East in Troy.

The treatment was recently given a statewide recommendation by the Michigan Spine Surgery Improvement Collaborative and has sparked interest from many other hospitals in the area.

Known as “Enhanced Recovery After Surgery,” the new plan reduces a patient’s reliance on opioids in their recovery, lowers their pain scores and can lead to shorter recovery times.

“We used our patients at Corewell Troy and we looked at patients prior to the study to compare results,” said Dr. Richard Easton, the chief of orthopedic surgery at Corewell Health East. “We used 192 consecutive spinal patients and compared them to 142 patients (using ERAS). That gave us a statistically significant number. We looked at scores and the effect on things like blood pressure and nausea. We wanted to show this new program was safe and effective. Our results were very impressive. … We used patients from 2019 and 2020.”

Medical professionals who oversaw the study said that this could radically improve the state of recovery for patients.

“This new approach has had some success and is key to team support from doctors, anesthesiology, nursing and allied services,” said Dr. Daniel Silvasi, the surgical director of clinical operations and the medical director of operating rooms at the hospital. “We’re changing the way things are done. We’re changing how staff is caring for patients and how patients are caring for themselves.”

One of the key improvements seen in the plan is the removal of the “pain button.” This was a button that allowed patients to self-medicate as needed, generally being administered traditional opioid painkillers. Instead, they used multiple modes of pain relief, from ibuprofen to muscle relaxers to other medications that were not opioids.

“For pain, we used to have the button. The patient would hit the button whenever they were in pain and get something like morphine. Now we have pain medication with a longer half-life, so a single dose stays in their system longer. We also use methadone, which can last up to 24 hours,” said Easton. “We found the patients used only 30% as many opioids than they were using after other surgeries.”

Easton said this resulted in a sharp reduction in the use of opioids, which could reduce the risk of becoming addicted.

“We had patients using 350 morphine milligram equivalents, which is the equivalent of pain medication used in comparison to morphine, prior to the study,” he explained. “After the study, patients have at least a 40% drop in their MME numbers. We looked at their pain scores and at 24 to 48 hours after the operation, we saw a significant drop in their pain values.”

Additional improvements also were seen through their new practices, which also stressed preventative and proactive treatment and tailoring the treatment for the specific patient.

“The old concept was that you would be at bed rest,” said Easton. “We (with ERAS) try to have patients up and moving within hours after surgery. There used to be no eating or drinking anything after midnight before surgery. We now have optimized nutrition and have them eating as soon as they can tolerate it after surgery. The old system was all about physical therapy after surgery. Now we have exercise classes and stress reduction both before and after surgery.”

Easton said that their hospital was ideally suited to test out such a new treatment plan.

“We have a unique population (at Corewell Health Beaumont Troy Hospital) where a lot of patients have had experiences at other hospitals,” he remarked. “By instituting our program, we could get feedback from them that showed lower pain scores (with ERAS). We had patients come out of anesthesia after surgery on ERAS saying, ‘I feel better than I did after three months’ on regular pain treatments.”

Easton said their findings have caught the attention of the Michigan medical community and they are hoping that their techniques are explored by more hospitals in the coming months.

“This was innovative, and we were the first hospital to do it, so we presented it to the Michigan Spine Surgery Improvement Collaborative, which is a collaborative of more than 27 hospitals. After our presentation, our results suggested that this was something the whole state should be using,” he said. “Other hospitals then started coming to us to look and see what we were doing, and we started helping them implement this across the state. All of their hospitals are now being asked by the collaborative to adopt this.”

The plan is to keep refining and improving the techniques they developed through their study to see if patient care can be improved even more.

“It is now in several Michigan hospitals,” said Easton. “Other hospitals are coming here and looking at what we’re doing. It’s a bit like a living creature, so it is always changing and improving. We are looking at ways to decrease bleeding now, for instance. We just presented a paper on it to the North American Spine Society in Chicago in October. Our goal is to keep improving and look for ways to make surgery better, more effective, safer and better at improving patient quality of life.”