Surgical recovery programme that cuts post-op chest infections by 50% to be rolled out across Greater Manchester

A surgical recovery programme that cut post-operative respiratory complications by 50 per cent at Manchester Royal Infirmary is set to be rolled out across a further six Greater Manchester hospitals.

A team led by Manchester University NHS Foundation Trust (MFT) has secured £500,000 from the Health Foundation to support the roll out and assess the impact of the successful surgery recovery programme from 2018.

The Enhanced Recovery After Surgery (ERAS+) programme was implemented at Manchester Royal Infirmary in 2014 following a successful pilot. It cut the average length of post-operative hospital stays by three days – as well as reducing respiratory complications by half – saving the trust over £500,000 a year.

The new funding will support the set up and evaluation of the programme at hospitals in Bolton, Oldham, Salford, Stockport and South Manchester. Cancer patients and others with long-term conditions will receive more consistent standards of care across the city region, which doctors believe will lead to better outcomes.

Sarah Lowe, aged 51, who lives in Whalley Range with her husband and three children, was diagnosed with ampullary cancer* after being admitted to Manchester Royal Infirmary with jaundice. She said: “I was given two to three weeks’ advanced notice of the surgery to remove the cancer and what helped me most was the support I received through the ERAS+ programme. I was told that something as simple as brushing our teeth and using mouthwash could help reduce the chances of a contracting pneumonia. 

“I felt empowered. I was part of the team preparing me for my surgery, not just a person this was all happening to. The programme let me take charge of my own care and feel that I was able to influence the outcome of my treatment. Working with a dietitian I put back on some of the weight I’d lost and I was also able to build up my fitness so I was as physically ready for the operation as possible.”

ERAS+ is a pre- and post-surgery training programme to improve recovery after major surgery. It aims to help patients to prepare for and contribute towards the management of their own healthcare by addressing the physical and psychological stress associated particularly with cancer, but also help to avoid chest complications which are common after surgery.

Dr John Moore is Adult Critical Care Clinical Director, Manchester Royal Infirmary and National Innovation Accelerator Fellow ERAS+. He said: “Chest complications are the most common significant problem after major surgery. ERAS+ aims to better equip patients and their families for preparation and recovery from major surgery – giving them a real opportunity to take charge of an element of their care. By helping them understand how so many different elements combine to affect their post-operative health, we can help people go into surgery as well prepared as possible.

“Now we want to roll this scheme out. By evaluating the expansion of the programme, we will also be able to share our learnings with other parts of the NHS and improve more patients’ experiences.”

In England, planned surgery accounts for more than 150,000 procedures each year (10,000 in Greater Manchester) and, of these, around 30% of patients are at risk of post-operative complications, which can increase the length of a typical hospital stay by up to seven days and reduce life expectancy for up to three years after surgery. Respiratory infection is the most common post-operative complication following major surgery.

Greater Manchester Health and Social Care Partnership, which brings the NHS, public health and local authorities together, provides a unique opportunity to rapidly adopt ERAS+ across the city region.   

Some of the areas the ERAS+ programme covers are:

• increased activity and better nutrition to prepare the body for surgery
• oral healthcare and chest exercises to help reduce chest problems
• post-surgery rehabilitation

Sarah Henderson, Associate Director from the Health Foundation, said: “We’re delighted to support the project team who’ll be working to improve surgical care in Greater Manchester. The team is one of seven outstanding project teams who have been selected because of their expertise in scaling complex improvement projects, and their ambition to achieve impact by improving care for patients.

“Working together, as part of the Scaling Up programme, we aim to make sustained improvements to health care by testing out proven interventions at a scale. We hope to see the interventions being widely adopted across the UK.”

Manchester University NHS Foundation Trust will lead the ERAS + Greater Manchester programme and will work in partnership with a wide range of organisations to deliver the project, including the NHS Transformation Unit, Haelo, Health Innovation Manchester and TRUSTECH.

^{*Ampullary cancer occurs in an area called the ampulla of Vater (after the anatomist who described it). This is a fleshy nipple where the pancreatic duct and bile duct meet and empty into the duodenum. Source: www.pancreaticcancer.org.uk}