Fast-Track Surgery May Reduce Complications Following Major Colonic Surgery

被引:119
作者
Zargar-Shoshtari, Kamran [1 ]
Connolly, Andrew B.
Israel, Lincoln H.
Hill, Andrew G. [1 ]
机构
[1] Univ Auckland, S Auckland Clin Sch, Middlemore Hosp, Auckland 1, New Zealand
关键词
Fast-track; Enhanced recovery after surgery; Colonic surgery; Complications;
D O I
10.1007/s10350-008-9386-1
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: Fast-track (enhanced recovery) care pathways for colonic surgery are becoming increasingly popular; however, there have been concerns regarding protocol compliance, high readmission rates, and also the true impact on morbidity rates with these protocols. This study was conducted to assess the impact of a fast-track program for colonic surgery on hospital stay, complications, and readmission rates. METHODS: From December 2005 to March 2007, consecutive patients undergoing colonic surgery were prospectively studied. The comparison group consisted of a comorbidity-matched group of patients who had undergone similar surgery before establishment of the fast-track program. RESULTS: Fifty patients were included in each group. Groups were comparable at baseline. The fast-track group received significantly smaller amounts of intraoperative and postoperative intravenous fluids, were fed earlier, mobilized earlier, passed flatus earlier, and were discharged earlier than the comparison group (4 vs. 6.5 days, P < 0.001). The numbers of patients with urinary infections (2 vs. 12, P = 0.008), ileus (5 vs. 18, P = 0.005), and cardiopulmonary complications (11 vs. 21, P = 0.032) were significantly lower in the fast-track group. There was no difference in the rate of readmission. CONCLUSION: Fast-track is a safe and effective approach for reducing hospital stay and morbidity following major colonic surgery.
引用
收藏
页码:1633 / 1640
页数:8
相关论文
共 40 条
[1]   Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery [J].
Andersen, J. ;
Hjort-Jakobsen, D. ;
Christiansen, P. S. ;
Kehlet, H. .
BRITISH JOURNAL OF SURGERY, 2007, 94 (07) :890-893
[2]   Randomized clinical trial of multimodal optimization and standard perioperative surgical care [J].
Anderson, ADG ;
McNaught, CE ;
MacFie, J ;
Tring, I ;
Barker, P ;
Mitchell, CJ .
BRITISH JOURNAL OF SURGERY, 2003, 90 (12) :1497-1504
[3]  
[Anonymous], COCHRANE DATABASE SY
[4]   Functional recovery after open versus laparoscopic colonic resection - A randomized, blinded study [J].
Basse, L ;
Jakobsen, DH ;
Bardram, L ;
Billesbolle, P ;
Lund, C ;
Mogensen, T ;
Rosenberg, J ;
Kehlet, H .
ANNALS OF SURGERY, 2005, 241 (03) :416-423
[5]   Colonic surgery with accelerated rehabilitation or conventional care [J].
Basse, L ;
Thorbol, JE ;
Lossl, K ;
Kehlet, H .
DISEASES OF THE COLON & RECTUM, 2004, 47 (03) :271-277
[6]   Supplemental perioperative oxygen and the risk of surgical wound infection -: A randomized controlled trial [J].
Belda, FJ ;
Aguilera, L ;
de la Asunción, JG ;
Alberti, J ;
Vicente, R ;
Ferrándiz, L ;
Rodríguez, R ;
Company, R ;
Sessler, DI ;
Aguilar, G ;
Botello, SG ;
Ortí, R .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2005, 294 (16) :2035-2042
[7]   Optimal duration of urinary drainage after rectal resection: A randomized controlled trial [J].
Benoist, S ;
Panis, Y ;
Denet, C ;
Mauvais, F ;
Mariani, P ;
Valleur, P .
SURGERY, 1999, 125 (02) :135-141
[8]   Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens - A randomized assessor-blinded multicenter trial [J].
Brandstrup, B ;
Tonnesen, H ;
Beier-Holgersen, R ;
Hjortso, E ;
Ording, H ;
Lindorff-Larsen, K ;
Rasmussen, MS ;
Lanng, C ;
Wallin, L ;
Iversen, LH ;
Gramkow, CS ;
Okholm, M ;
Blemmer, T ;
Svendsen, PE ;
Rottensten, HH ;
Thage, B ;
Riis, J ;
Jeppesen, IS ;
Teilum, D ;
Christensen, AM ;
Graungaard, B ;
Pott, F .
ANNALS OF SURGERY, 2003, 238 (05) :641-648
[9]  
Brasel K, 2007, CAN J SURG, V50, P214
[10]   Effect of morphine and incision length on bowel function after colectomy [J].
Cali, RL ;
Meade, PG ;
Swanson, MS ;
Freeman, C .
DISEASES OF THE COLON & RECTUM, 2000, 43 (02) :163-168