To celebrate the MUHC’s 25th anniversary, we interviewed Dra. Liane Feldman, Surgeon-in-Chief of the MUHC, on the evolution of surgical practices in our hospitals over the past quarter of a century.
What have been the main changes at the MUHC over the past 25 years?
There have been major efforts to improve recovery after surgery and reduce hospital stay and complications. Two of the main strategies for this are the use of more minimally invasive surgery, laparoscopic and robotic surgery, as well as enhanced recovery after surgery (ERAS) pathways.
As a tertiary and quaternary institution, we have contributed to the regionalization of complex care. This is part of our mission at the MUHC. There are many examples such as thoracic surgery, sarcoma, trauma, transplant, cardiac surgery, vascular and many others. We have specialized much more.
And of course the move to Glen was pivotal. The facilities are beautiful and the operating room is state of the art. The renovations at the MGH and the redevelopment of Lachine are also exciting projects.
Can you explain more about the pathways to improved recovery after surgery and their impact on decreasing hospital stay and complications?
Enhanced Recovery After Surgery, or ERAS itineraries, is a multidisciplinary care pathway that helps to standardize all the different care elements around the operation. This starts with how we optimize and educate patients before surgery, to the use of advanced surgical and anesthetic techniques that reduce pain, to how we provide nutrition and exercise well in advance. It includes about 20 different elements of attention.
Colorectal surgery is a good example of the impact of ERAS. Twenty-five years ago, when we were using open surgery and traditional care, patients used to spend at least a week in the hospital. This was just routine. Now, thanks to this new approach, our colorectal surgery team has reduced the length of hospital stay to less than 3 days and, amazingly, about 25% of our patients go home in same day of surgery. We are using digital health applications for remote monitoring. This is a great success story because not only does it have very high patient satisfaction, but it opens up hospital beds to allow more patients to access these resources.
Removal of a kidney by laparoscopic surgery at the MUHC
What are the challenges moving forward?
Surgery is better and safer now, and often the best way to cure disease and improve quality of life. Nowadays, even sick patients with comorbidities can benefit from surgery. With our aging population, there are more patients who need and can benefit from surgery. This is good, but our ability to provide access to all these patients has not been sustained. Not only are we short of staff, but there are also the growing needs of the population.
MUHC was a leader 25 years ago as an early adopter of minimally invasive surgery, and 15 years ago as an early adopter of ERAS. Now we must prepare ourselves to be able to lead the next 25 years. Surgery will continue to evolve and become less invasive, but to keep up we need new robotic equipment, new people with these skills, new training approaches, and interventional science research and innovation programs.
Where were you 25 years ago?
I think it was here at the MUHC! In 1997 I was head of resident. I was at Montreal General Hospital, also quite pregnant in November 1997. My son Zach will be 25 in January, he was born right after the ice storm.
Removal of a kidney by laparoscopic surgery at the MUHC