Duke Anesthesiology is among the first departments in the country to implement an Enhanced Recovery After Surgery (ERAS) program. Through close collaborations with Duke Surgery and the rest of the perioperative team, patient outcomes and length of stay have continued to improve for those undergoing major non-cardiac surgery. The GVT Division has developed enhanced recovery pathways for colorectal surgery, hepatobiliary surgery, liver resections, cystectomy, and living donor kidney transplantation. These pathways include both regional and multimodal analgesia, as well as individualized fluid management to enable early DRinking, EAting and Mobilizing after major surgery (known as DrEaMing or “living the DrEaM”). The Duke enhanced recovery pathway for colorectal surgery has halved the median length of stay for colorectal surgery over the last eight years, as well as reduced costs, complications and readmissions. The non-epidural colorectal enhanced recovery pathway has enabled many patients to be discharged on postoperative day one or two after colorectal resections. Similar improvements have been seen for other enhanced recovery programs.
While anesthesia complications per se are rare, patients undergoing major abdominal surgery can suffer significant morbidity. Duke Anesthesiology believes that perioperative medicine is the “practice of patient-centered, multidisciplinary and integrated medical care of patients from the moment of contemplation of surgery until full recovery.” Many patients undergoing major abdominal and vascular surgery will benefit from perioperative optimization programs which have been developed by Duke Anesthesiology, including its preoperative anemia clinic, preoperative diabetes clinic and perioperative nutrition service.
The GVT Division has also developed opioid-free and opioid-sparing pathways for patients undergoing more minor surgery, such as laparoscopic cholecystectomy. The opioid-free laparoscopic cholecystectomy pathway, developed by Dr. Michael Manning, has enabled many patients to leave the hospital on the same day of surgery without receiving or requesting any opioids.
Under the leadership of Dr. Timothy Miller, proficiency in perioperative care of liver transplant patients at Duke has grown to national prominence. Aside from access to highly skilled and experienced physicians, liver transplant patients at Duke benefit from shorter wait times and significantly higher survival rates than the national average. The GVT Division also provides care to patients undergoing kidney and pancreas transplants, and has expanded its services to include small bowel transplantation. The liver transplant team includes Drs. Timothy Miller, Sandy An, Brian Colin, Jonathan Dunkman, Sarada Eleswarpu, Michael Manning, Arturo Suarez, Ankeet Udani, and David Williams.