In her Presidential Address at last night’s Convocation, Julie A. Freischlag, MD, FACS, FRCSEd(Hon), DFSVS, MAMSE, acknowledged the toll that the coronavirus (COVID-19) pandemic has taken on surgeons and patients and posited that surgeons can move forward by applying the principles of enhanced recovery after surgery.

“As leaders and as surgeons, COVID-19 has brought a storm of challenges we never could have imagined—from delays in elective procedures to redeployment of staff, financial strain, and new safety practices. There also have been silver linings where we have seen the most amazing acts of bravery and teams come together stronger than ever,” according to Dr. Freischlag, chief executive officer of Wake Forest Baptist Health, dean of Wake Forest School of Medicine, and chief academic officer of Atrium Health Enterprise, Winston-Salem, NC.

“Today’s address is about recovery—a word we have heard often over the past 18 months in our surgical circles and beyond. I’ll talk about enhanced postoperative recovery after surgery and how lessons learned from this approach can be applied as we step closer to the other side of the pandemic,” she said.

Dr. Freischlag titled her talk “#SurgeonsSowingHope” as a charge for Fellows to enhance recovery, elevate healing, and spread hope to their patients, communities, teams, and themselves. “I encourage all of us to share the many ways we are sowing hope with this hashtag on social media,” she said.

“Hope for improved health is a driver behind enhanced recovery after surgery,” Dr. Freischlag said, noting that this approach “aims to medically optimize the health and safety of patients before surgery—on day one—and throughout the continuum of care.” More specifically, it relies on a combination of evidence-based guidelines drawn from patient education and engagement, multidisciplinary teamwork, screening tools, nurse navigation, and patient champions to support the whole patient throughout the surgical journey.

Two recent studies published in the Journal of Vascular Surgery quantified some of the benefits, she said. The first examined implementation of an enhanced recovery bundle in patients with lower extremity bypass. Patients in the enhanced recovery program had decreased length of stay when compared with patients who were not in the program. In addition, variable costs declined from approximately $18,000 to $13,000.

The second study examined patients undergoing abdominal aortic aneurysm repair with an enhanced recovery program versus patients undergoing standard, open repair. The enhanced recovery cohort experienced reduced time to discharge and improved postoperative outcomes, such as early ambulation and feeding.

“Enhanced recovery is a theme we can apply on an even larger scale as we begin to emerge from the pandemic,” Dr. Freischlag said. Many of the same principles that underlie this approach to optimization—collaboration, compassion, inclusion, engagement, and innovation—can guide us as we heal, recover, and lead moving forward.”

An estimated 52 percent of surgeons reported experiencing burnout during the height of the pandemic. “Delays in care affected each of us and had far-reaching implications,” Dr. Freischlag said.

“And, most importantly, the pandemic showed us the devastating impact of long-standing health disparities in our underserved communities. COVID-19’s disproportionate effect on communities of color is staggering, with one study reporting that more than one-third of COVID-19 deaths” have been among Black people and other people of color. “We know we can—and must—do so much better,” she said.

“How do we begin to recover and also ensure that we improve along the way? I want to go back to the values that frame enhanced recovery after surgery—compassion, collaboration, inclusion, engagement, and innovation—and share how we’re putting these into action with our surgical teams and patients,” Dr. Freischlag said.

“The pandemic created a paradigm shift, pushing us to innovate quickly. Telehealth emerged as a safe, convenient, and lower-cost alternative to in-person visits, while still allowing us to engage with and include patients in their care,” she noted. Although telehealth provides enhanced benefits, it also poses barriers to access for underserved communities, such as low-income and rural populations, that may not have access to an Internet connection.

“With enhanced recovery comes the incredible opportunity to be ambassadors and advocates for equity and inclusion,” Dr. Freischlag said. “Every patient, regardless of background, race, gender, or ethnicity, deserves access to equitable care and treatment, and we have seen this more than ever during the pandemic.”

“At the heart of enhanced caring is compassion,” which can be defined as the emotional response to another person’s pain or suffering, involving an authentic desire to help, she said. Compassion in health care has many benefits, including improved patient outcomes, reduced costs, time savings, and lower levels of physician burnout.

Unfortunately, many physicians say they do not have time for compassion. But research shows it takes only 40 seconds to create a meaningful connection with a patient. “This finding made me pause and think, what can I do in just 40 seconds to make a compassionate connection and difference?” Dr. Freischlag said. “For me, it is treating patients how I would want my own family treated: Asking, ‘How do you feel, and what are you hoping for?’”

Part of enhancing recovery among health care professionals “means taking the time to say ‘thank you’ and celebrating the incredible work and sacrifices our health care heroes have made,” she said.

“Lastly, enhanced care and recovery take true teamwork based on communication, trust, transparency, and opportunity,” Dr. Freischlag said. “When we provide opportunity and empower others, our teams become stronger, and together we go further.”

She also encouraged surgeons to take care of themselves. “This can take many forms: making new connections, celebrating small wins, doing good deeds, and practicing gratitude,” Dr. Freischlag said.

She encouraged surgeons to turn to the ACS to enhance their recovery. “My friendships over the years with other members have always sustained me, but even more so during the pandemic,” Dr. Freischlag said.

“Today marks an incredible accomplishment for each of you, and I encourage you to get involved and engaged with this amazing organization and network of people, who will become your friends, advocates, and closest professional collaborators,” she said.