This red bag, available only at IU Health, can help you fly through surgery
Few people would dream of attempting a marathon without doing at least some training. Yet most people head into surgery without preparing themselves at all for the experience.
An Indiana University Health doctor hopes to change that with a red bag.
It’s not the bag itself that makes the difference, but what’s inside: a supplement to drink for a few days before surgery to prime the immune system, addressing nutritional deficiencies that could impact the outcome, as well as items to reduce the risk of infection.
“If you don’t correct this before you have surgery, you have a higher risk of complications. The reality is most of us are not healthy enough (for surgery),” said Dr. William Wooden, director of operative services at IU Health and the James E. Bennett Professor of Surgery at IU School of Medicine. “It doesn’t matter if you’re malnourished or ill or young, we can improve your immune system.”
A pilot project Wooden conducted provided statistics to back up his claims. Patients who followed the protocol before surgery had shorter hospital stays, lower chances of returning to the hospital, and half the rate of overall complications.
3-D medicine: New technology can help make new knees, even new tissue
Not just for Boomers: Why millennials are flocking to Botox
IU Health officials are paying attention. Last year, IU Health distributed 4,000 of the red bags, known formerly as “pre-operative wellness kits,” at its two Downtown hospitals.
Now, the health system plans to roll out the program at all of its 14 hospitals in the coming years. IU Health officials estimate that eventually they will spend more than $2 million a year on the bags.
This decision puts Indiana University Health at the forefront of hospitals, said Dr. Tong Gan, founder and president of the American Society for Enhanced Recovery, a non-profit organization devoted to increasing awareness about best practices for patients facing surgery.
While more hospitals are catching on to the movement, which was started by a Danish surgeon, only about 10 to 15 percent have enhanced recovery protocols in place.
Studies have shown that such practices not only improve patient care and decrease post-surgical pain and use of opioids, they can also save money. Gan and his colleague did a study that showed that on average, pre-surgical measures save more than $2,000 per patient. About 30 percent of patients have savings of more than $4,000.
“It’s almost like a no-brainer,” said Gan, a professor of anesthesiology and chair of the department of anesthesiology at Stony Brook University.
Wooden’s work as a plastic surgeon inspired his interest in better preparing patients for surgery. Often he found himself at the bedside of patients slow to heal their surgical wounds in part because of poor nutritional status. Some subsisted on fast food and lacked essential nutrients.
During Wooden’s training, he met a University of Pittsburgh surgeon who had helped Nestle develop Impact Advanced Recovery, a supplement that aims to boost the immune system before surgery. Impact AR contains arginine, an amino acid; certain nucleotides; and fish oil, which helps fight inflammation. Studies had shown that patients who drank this supplement for a few days before surgery did better afterwards than those in a control group.
For a while, Wooden experimented with giving pre-surgical patients a prescription to purchase this supplement. Soon, he realized, they’d be more likely to drink it if the hospital just provided it.
In 2012, he received a nearly $1 million grant from IU Health to test that theory. He used the money to order 7,500 bags. Each bag is stocked with a five-day supply of Impact AR, an incentive spirometer to encourage deep breathing to prevent pneumonia, and antiseptic soap to guard against skin infections. The bags also contained a pedometer to encourage exercise and chewing gum. Patients also received prescriptions for antibiotics.
A purple check sheet in the bag instructs patients on how to use the items and advises them to drink three servings of Gatorade in the 24 hours before surgery, the last at least three hours before the operation. That recommendation goes against the conventional wisdom that surgical patients should consume nothing in the hours before the operation. Studies have shown patients do better when they have liquid calories in their bodies rather than entering the operating room dehydrated.
All these measures combined paid off. Wooden’s trial showed that general surgery patients who used the bags spent only 6.5 days in the hospital compared to 18 days for those who did not. Ten percent needed to be readmitted, compared with 19 percent for those who did not have the bags. Just over a quarter had either an infectious or non-infectious complication compared with half of those in the control group.
The statistics led Wooden to convince IU Health administration to invest in extending the program to all patients scheduled for surgery. In some instances, patient may need to delay surgery to better prepare their bodies for the procedure.
“My job is to help us establish a higher standard,” he said. “We want to reset the standard across our entire health care system.”
When Carmel resident Dick Snyder underwent bypass surgery eight years ago, patients received little in the way of pre-op materials. So Snyder was surprised to receive the red bag in advance of his mid-March surgery to remove two skin cancers on his scalp.
At first, Snyder, 81, said he didn’t know what to think.
He followed the instructions to the letter, drinking all of the immune boosters he received, practicing his breathing as often as possible and carefully using the antibacterial soap and ointment.
These efforts, he believes, helped result in a complication-free experience with minimal pain.
“I think it conditioned me for what I was in store for …. I didn’t know what to expect,” he said.
“To me, it wasn’t so much the nutrient. It was kind of a wake-up call that I’m going to be there for a few days and they’re preparing me for it. And that was kind of neat.”
Call IndyStar staff reporter Shari Rudavsky at (317) 444-6354. Follow her on Facebook and Twitter.