A Fast-Track Program Reduces Complications and Length of Hospital Stay After Open Colonic Surgery

被引:356
作者
Muller, Sven
Zalunardo, Marco P. [2 ]
Hubner, Martin
Clavien, Pierre A.
Demartines, Nicolas [1 ]
机构
[1] CHU Vaudois, Univ Hosp, Dept Visceral Surg, CH-1011 Lausanne, Switzerland
[2] Univ Zurich Hosp, Inst Anesthesiol, CH-8091 Zurich, Switzerland
关键词
RANDOMIZED CLINICAL-TRIAL; INTRAVENOUS FLUID RESTRICTION; EPIDURAL ANALGESIA; MULTIMODAL OPTIMIZATION; COLORECTAL SURGERY; ENHANCED RECOVERY; SURGICAL CARE; RESECTION; REHABILITATION; CANCER;
D O I
10.1053/j.gastro.2008.10.030
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background & Aims: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery. Methods: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care. The primary end point was the 30-day complication rate. Secondary end points were severity of complications, hospital stay, and compliance with the fast-track protocol. Results: The fast-track protocol significantly decreased the number of complications (16 of 76 in the fast-track group vs 37 of 75 in the standard care group; P = .0014), resulting in shorter hospital stays (median, 5 days; range, 2-30 vs; 9 days, respectively; range, 6-30; P < .0001). There was a trend toward less severe complications in the fast-track group. A multiple logistic regression analysis revealed fluid administration greater than the restriction limits (odds ratio, 4.198; 95% confidence interval, 1.7-10.366; P = .002) and a nonfunctioning epidural analgesia (odds ratio, 3.365; 95% confidence interval, 1.367-8.283; P = .008) as independent predictors of postoperative complications. Conclusions: The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as standard care. Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program.
引用
收藏
页码:842 / 847
页数:6
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