Patients undergoing Liver operations at Royal Surrey County Hospital have seen the average length of their hospital stay cut from 14 to six days thanks to a comprehensive system of pre-operational care developed at the Trust.
Post-operational complications among Liver patients have also been reduced from 27% to just 6% as a result of the Enhanced Recovery and Pre-habilitation (ERP) programme making Royal Surrey England’s leading hospital for Enhanced Recovery in Liver surgery. Many units across the country are trying to implement similar programs and visit the Trust’s unit for advice and mentoring.
Under the ERP model, all pre-operative patients undergo a holistic assessment involving surgeons, dieticians, occupational therapists, physiotherapists and many other medical professionals. This identifies any potential problems patients may have before surgery. Many liver patients have weakened immune systems from cancer and chemotherapy or are elderly so raising their resilience and overall level of health means they are much better prepared to undergo invasive surgery and recover more quickly.
“It’s about getting it right first time,” said Consultant Hepato-Pancreato-Biliary (HPB) Surgeon and Chief of Service for Diagnostics and Clinical Support in Royal Surrey’s Surgery Unit, Angela Riga. “We use a similar model for pancreatic patients although their more complex needs mean these patients start ERP treatment four to six weeks before surgery.”
The dramatic improvement in recovery times thanks to ERP means that Royal Surrey is now able to treat far more patients. Around 180 Liver operations a year are performed at the Trust and up to 110 Pancreas operations. Royal Surrey is also the first hospital in England to start a long-term study of the impact of pancreatic cancer.
“ERP is a model that can be adapted across a wide range of surgical procedures,” said Angela. “Royal Surrey’s orthopaedic department is currently piloting the process for hip and knee joint replacements which would allow patients to return home on the same day.”
Royal Surrey’s HPB unit treats a wide range of conditions such as cancer of the liver and pancreas, pancreatitis, gallstones, jaundice, liver and pancreas cysts, small bowel tumours and many more. The Trust receives referrals from over a dozen other hospitals and has a catchment area covering a population of more than 2.5 million.
The HPB unit is made up of five HPB Surgeons, three dedicated Specialist Dieticians, four Specialist Nurses, three Interventional Radiologists, three Oncologists, four Hepatologists, Specialist Anaesthetists and Intensivists. The unit is also supported by Physiotherapists, Occupational Therapists and a Psychologist.