Seventy-one-year-old retired firefighter, Dan Kelly remembers the day following his second hip replacement surgery at Royal Jubilee Hospital.
“The morning after surgery I woke up at home and it was like I hadn’t had an operation,” says Kelly. “I walked out to my deck, sat and had a coffee, didn’t feel anything and didn’t need a cane. It was amazing!”
Before the following morning, however, Kelly was seemingly feeling comfortable.
In a clip posted by Island Health, Kelly can be seen standing up from a seated position and doing a little jig. His dance moves came just one hour after being in a Royal Jubilee Hospital operating room with Victoria orthopedic surgeon Dr. Duncan Jacks and anesthetist Dr. Jacques Smit receiving surgery.
“It’s a miracle. You endure all this pain for months and then there’s nothing – it’s like normal again,” said Kelly.
Kelly’s second hip replacement surgery was performed under the Victoria Enhanced Recovery Arthroplasty Program (VERA), a pilot project being undertaken by Island Health.
VERA, which is modelled after similar programs in Eastern Canada, is aimed at reducing a patient’s post-surgical pain and shortening their recovery time, according to Island Health.
The new program also focuses on allowing suitable patients for a same-day discharge within hours of surgery – like in Kelly’s case who had morning surgery and was home before lunch.
“To witness these new protocols working as well as they have and not see the same levels of pain, not see the nausea, vomiting, dizziness – all the complications commonly experienced by our patients after a big operation is extremely satisfying for me as a surgeon,” says Dr. Jacks.
Under the new protocols, hip and knee replacement patients are administered an epidural along with sedation. According to anesthetist Dr. Smits, the medications target a variety of different pain pathways and the epidural puts the “freezing on the outside of their spinal fluid” in a place known to medical professionals as the epidural space.
“We can get these patients mobilized much faster because that residual weakness the spinal anesthesia used to cause which prevents patients from walking wears off extremely quickly – within half an hour after the surgery,” Dr. Smit adds.
In Kelly’s case, Dr. Jacks said that his motor functions returned “almost immediately” after the epidural was turned off, enabling him to get up and walk within an hour of surgery.
Island Health points to another drawback of the traditional approach is the worry of dislocating a hip during the recovery process. The new VERA protocols have doctors spending more time “closing some of the soft tissues around the hip” to help eliminate dislocation concerns and speed up recovery, Dr. Jacks highlighted.
Kelly is one of eight patients who have participated in the VERA project and Island Health says that all participants have been discharged to home on the same day of their surgeries.
“I’d like to see these protocols applied to all patients because I think not just the same day patients such as Dan can benefit,” says Dr. Jacks. “All patients who require hip and knee replacements ultimately can benefit from the new protocols even if they stay with us for an overnight or longer stay.”
According to Island Health, more patients will be enrolled in the VERA program, likely in the fall.
Medical professionals have an interest in expanding the VERA program to help with the backlog of surgeries from COVID-19 and to reduce the impact of surgeries on hospital capacity.
Graham Cox
