Implementation of a perioperative multimodal rehabilitation protocol in elective colorectal surgery. A prospective randomised controlled study

Introduction: Multimodal rehabilitation (MMR) consists of a combination of several methods for management of the surgical patient, designed to reduce the response to surgical stress and a more comfortable and earlier recovery. Objective: To assess the implementation of an MMR protocol in a Colorectal Surgery Unit, and to compare the results with the traditional model, as well as assessing its efficacy as regards recovery and hospital stay. Material and methods: A total of 119 patients who received elective surgery for colorectal diseases in a period during 2009-2010 were prospectively and randomly analysed. The patients were divided into 2 groups: 58 patients were assigned to the traditional group and 61 to the MMR group. The MMR group protocol consisted of, preoperative education, early feeding and mobilisation. Results: Both groups were homogeneous as regards the preoperative variables evaluated, the type of disease and the procedures carried out. The nasogastric tube was kept in place for 4 (1-9) days compared to 1 day (0-2) in the MMR group, with no differences in the number of re-insertions. Significant differences were found in the introduction of a liquid diet (3 [1-5] days traditional versus 0 [0-2] MMR) (P < .001), and passing of first flatulence (3 [1-6] days traditional versus 1 [1-3] MMR) (P < .001). The MMR group had a postoperative stay of 4.15 +/- 2.18 versus 9.23 +/- 6.97 days in the traditional group (P < .001). No significant differences were found in complications or readmissions. Conclusions: MMR in colorectal surgery in the Spanish public health system is feasible and enables surgical patients to have a faster recovery without increasing complications, leading to an earlier hospital discharge. (C) 2010 AEC. Published by Elsevier Espana, S.L. All rights reserved.