Enhanced Recovery Plan After Cytoreductive Surgery and HIPEC for PSM
After cytoreductive surgery and HIPEC, you will require significant care to recover. On average, patients stay in the hospital for 10 to 12 days. During this time, your recovery care team will monitor you closely.
They will use a proven strategy called an enhanced recovery after surgery (ERAS) protocol (or plan) to manage your pain, prevent complications and help you heal.
What to Expect During ERAS Protocol After HIPEC for PSM
Immediately after surgery, you will go to the post-anesthesia recovery room for a few hours while you wake up. Once you’re awake, you’ll go to a private recovery room or to the intensive care unit (ICU).
In either case, an experienced team will continuously and carefully monitor you for any complications. These may include infection, wound separation, leaks in the abdomen and lung problems. Your team will also ensure you have adequate nutrition and manage your pain.
Your surgeon will check on you frequently to look for any changes in your condition and continue to direct your care. The rest of your recovery team will include:
- An internal medicine specialist
- A surgical oncology nurse practitioner
- Pain specialists
- Staff nurses, technicians and social workers
- Medical students and surgical residents
- A physical therapist
Tubes and Drains
When you wake up, you will notice some temporary tubes and drains in your body, such as:
- Intravenous (IV) lines: These tubes in your arms deliver fluids, nutrition and medications as long as they are needed.
- Foley catheter: This flexible tube drains your bladder, staying in place for a few days after surgery.
- Chest tube: This tube removes fluid, blood and air from your lung area. You will only have one if surgery is done around your diaphragm.
- Jackson-Pratt (or JP) drains: These bulb-like drains collect bodily fluids from surgical sites. They are usually removed before you go home, but some patients need them to stay in place for a few extra days.
You will receive medications through an IV until you are able to take them by mouth. Shortly after surgery, your team will prescribe medications to help:
- Manage pain
- Decrease acid in the stomach
- Prevent the formation of blood clots
- Prevent nausea and vomiting
- Soften stools
When you come out of the operating room, a dressing will cover your incision. This bandage will be removed by the surgical team on the first day after surgery. Once that dressing is removed, the incision can be exposed to air.
Your team will monitor the wound for any signs of infection. If there is an infection, they may open the skin to drain the area and change the dressing daily.
Your bowel function and ability to eat normal foods will return slowly over a few days. The timeline is different for every patient.
As your bowel begins to “wake up,” we will gradually increase the amount of food you can have and give you some variety. Immediately after surgery, you will receive all nutrition through an IV. Eventually, you will be able to drink clear liquids, such as water, juice and broth — and eat Jell-O and popsicles.
When you begin to pass gas (a sign your bowels are waking up), you will be allowed “full” liquids, such as thicker soup broth, milk, ice cream and yogurt. Eventually, you will advance to soft food, including eggs, cream of wheat, soup and pureed vegetables and meat.
Early walking is the best way to prevent complications after surgery. You will probably stay in bed the day of surgery. But your team will ask you to sit up in a chair that evening and encourage you to walk with assistance the very next day.
Walking is important because it:
- Stimulates bowel and bladder function and circulation
- Prevents blood clots
- Improves lung function
- Increases muscle tone
- Helps balance and coordination
- Increases independence
When you reach certain recovery milestones, your team will begin to prepare to send you home.