Tan Tock Seng programme quickens post-surgery recovery, saving patients $2,197 each

Dr How Kwang Yeong, a consultant in Tan Tock Seng Hospital's (TTSH) Colorectal Service, with Ms Michelle Tan. After keyhole surgery in January to remove her stage 3 colon cancer, Ms Tan was able to walk out of the hospital the next day in part due to a protocol at TTSH that optimises patients' post-surgery recovery. ST PHOTO: LIM YAOHUI

SINGAPORE - Like all other patients, Ms Michelle Tan was hoping for a quick recovery after keyhole surgery in January this year to remove her stage 3 colon cancer.

But little did she expect to walk out of the hospital the next day - three days earlier than the average colorectal surgery patient.

Ms Tan's exceptionally speedy recovery was in part due to a protocol at Tan Tock Seng Hospital (TTSH) that optimises patients' post-surgery recovery.

Since 2016, the Enhanced Recovery After Surgery (Eras) programme has led to cost savings of an average of $2,197 for each of the more than 700 colorectal surgery patients, and almost halved the average length of hospital stay from 10.6 days in 2015 to 5.8 days this year.

The programme has also reduced the proportion of patients who have severe complications post-surgery, from 5.42 per cent in 2015 to 2.8 per cent this year.

The proportion of patients who are readmitted to the hospital within a month has also gone down, from 10.26 per cent in 2015 to 6.8 per cent this year.

Most of the patients who benefited from the programme had undergone colorectal surgery, with the remaining patients from specialities such as upper-gastro intestinal, liver, pancreas and urology.

The programme involves steps that aim to reduce patients' stress before the operation and promote their well-being thereafter, said Dr How Kwang Yeong, a consultant in TTSH's Colorectal Service.

For example, patients no longer need to have bowel preparation or fast from midnight before surgery, and need only take clear fluids or a carbohydrate drink two hours before.

After the operation, doctors remove nasogastric tubes and drains - used to remove excess fluid or gas in the stomach - from the patient and a few hours later, the patients are encouraged to sit, walk, eat and drink, instead of resting in bed for days or fasting until their bowel functions return to normal.

Ms Tan, 49, an administrative clerk, was asked to take nutritional supplements, have a good diet and maintain an active lifestyle.

"I was quite surprised that I didn't feel much pain after the surgery and could eat, and didn't feel like vomiting," she said.

"Four hours after the surgery, I was able to get out of the bed and walk, and could walk on my own the next day."

Still, some patients, especially the elderly, are resistant to the programme as they think that they should stay in bed and rest after surgery, said Dr How.

"We try to dispel these notions and sometimes we have to be a little bit more firm with them, to get them out of bed first and take a few steps to gain confidence," he added.

Because of its encouraging results, the programme will be expanded at the end of the year to other forms of surgery, such as breast, ear, nose and throat, as well as knee replacement surgery.

TTSH has also started other initiatives.

Last year, targeted interventions were started for frail patients older than 65 and who are undergoing major surgery at TTSH.

These patients, who are also under the Eras programme, go through a four-week structured exercise programme to enhance their functional capacity before surgery and improve their tolerance to surgery stress.

They also undergo a more intensive post-surgery rehabilitation programme during the month after surgery.

TTSH is also developing an app - called the Surgical Enhanced Recovery Assistant - for the Eras programme that will enable patients to input their basic health data, and for the care team to track and monitor their progress and compliance to nutritional and exercise targets, said Dr How.

He will be presenting on the Eras programme at the Eras Asia Congress held at Suntec Singapore Convention and Exhibition Centre from Friday (Sept 27) to Saturday.

About 250 healthcare professionals, including surgeons, nurses and allied health professionals, will be attending the event to share Eras practices.

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