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HCA Healthcare’s Innovative Approach to Surgical Recovery Promotes Better Outcomes, Decreased Opioid Usage and Faster Recovery Times for Patients

HCA Healthcare, Inc. (NYSE: HCA), one of the nation’s leading healthcare providers, today announced its enterprise-wide adopted Enhanced Surgical Recovery (ESR) program, a patient-centered, research-based, multidisciplinary approach to surgical recovery. The ESR program has been adopted by 167 HCA Healthcare facilities and has demonstrated significant improvements in surgical recovery, including a two-day average reduction in length of hospital stays and an up to 44% decrease in opioid usage for some surgeries.

“After studying more than 20 years of clinical research and peer-reviewed publications in addition to our own internal data, we discovered that a facility making a few key changes, such as using multimodal approaches to managing pain and encouraging patients to eat and walk around within 24 hours after surgery, can have a significant impact on a patient’s recovery,” said Dr. Randy Fagin, Chief Medical Officer of HCA Healthcare’s National Group. “From the physician’s office prior to surgery to follow-up care, a facility’s ESR program allows patients to play an active role in managing their own care and recovery plan.”

ESR uses select pre-, intra- and post-operative interventions designed to improve outcomes and the patient experience. The program was derived from Enhanced Recovery after Surgery (ERAS), a recovery program that has been standard practice in Europe for a number of years and consists of up to 21 components. HCA Healthcare’s ESR focuses on the six tactics believed to have the greatest impact on patient outcomes:

  1. Goal-directed fluid therapy: active monitoring of a patient’s fluid balance to achieve an optimal hydration level throughout surgery.
  2. Patient education: equipping patients with a personal recovery checklist so they can play an active role in their care.
  3. Multimodal pain management: an individualized approach only using opioids on an as-needed basis and instead using non-opioid pain relievers and other pain management techniques.
  4. Permissive pre-op hydration/carb loading: drinking fluids and a carbohydrate-rich drink before surgery to improve hydration and insulin resistance as well as to curb nausea.
  5. DREAM = drink, eating and mobilization within 24 hours post-op: encouraging patients to drink, eat and move shortly after their surgery.
  6. Multidisciplinary team: creating a group of team members, including a surgeon champion, an anesthesia champion, nursing and pharmacy, who work together to guide the facility’s program and each patient’s care journey.

Jared Stockett, a double knee replacement patient at HCA Healthcare’s West Valley Medical Center, is one of more than two million patients who have participated in the ESR program adopted by facilities throughout HCA Healthcare. “The surgeries went really well. Each time I went in at 8 a.m., the surgery started around 10 a.m. and I went home around 3 p.m. that afternoon. By the time I left the hospital, I had already been up and walking with a walker,” said Stockett. “Three days after each surgery, my knee already felt better. By following the instructions from my care team, recovery went very smoothly.”

As a learning health system, HCA Healthcare uses data from approximately 35 million annual patient encounters to share best practices and focus on continuously improving care. Based on data collected from 141,482 joint replacement, gynecologic oncology, colorectal and bariatric surgeries in 2021, the ESR protocol has shown to be a proven roadmap to help improve surgical results, including:

  • A 2.1-day reduction in length of stay;
  • A 54% decrease in 30-day readmissions for joint replacements;
  • A 45% decrease in 90-day readmissions for gynecological surgery;
  • Up to a 44% decrease in opioid usage; and
  • 2.4 million fewer morphine medications dispensed.

Based on these outcomes delivered to patients, HCA Healthcare invested an additional $20 million in monitoring equipment to support expanding the program to other surgical service lines in 2021.

About HCA Healthcare

Nashville-based HCA Healthcare is one of the nation’s leading providers of healthcare services comprising 182 hospitals and approximately 2,300 ambulatory sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 20 states and the United Kingdom. With its founding in 1968, HCA Healthcare created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. HCA Healthcare has conducted a number of clinical studies, including one that demonstrated that full-term delivery is healthier than early elective delivery of babies and another that identified a clinical protocol that can reduce bloodstream infections in ICU patients by 44%. HCA Healthcare is a learning health system that uses its more than 35 million annual patient encounters to advance science, improve patient care and save lives. Please click here to connect with HCA Healthcare on social media.

All references to “Company,” “HCA” and “HCA Healthcare” as used throughout this document refer to HCA Healthcare, Inc. and its affiliates.



Frank Morgan



Harlow Sumerford


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