Original Article

International Journal of Colorectal Disease

, Volume 23, Issue 1, pp 93-99

“Fast-track” rehabilitation for elective colonic surgery in Germany—prospective observational data from a multi-centre quality assurance programme

  • W. SchwenkAffiliated withGeneral-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin Email author 
  • , N. GüntherAffiliated withGeneral-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin
  • , P. WendlingAffiliated withChirurgische Klinik I, Krankenhaus Bad Soden, Kliniken des Main-Taunus-Kreises GmbH
  • , M. SchmidAffiliated withKlinik für Allgemein- und Viszeralchirurgie, Westpfalz-Klinikum GmbH Standort III Kirchheimbolanden
  • , W. ProbstAffiliated withKlinik für Allgemein- und Viszeralchirurgie, Ammerland Klinik GmbH
  • , K. KipfmüllerAffiliated withKlinik für Allgemein- und Viszeralchirurgie, Sankt-Marien Hospital
  • , B. RumstadtAffiliated withKlinik für Allgemein- und Viszeralchirurgie, Diakoniekrankenhaus Mannheim
  • , M. K. WalzAffiliated withKlinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Klinikum Essen Mitte
  • , R. EngemannAffiliated withChirurgische Klinik I Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Aschaffenburg
    • , T. JunghansAffiliated withGeneral-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin
    • , “Fast-track” Colon II Quality Assurance Group

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Abstract

Background

The results of “Fast-track” colonic surgery in an unselected population outside of specialised units has been unknown yet.

Materials and methods

Data from 24 German hospitals performing “Fast-track” rehabilitation as the standard peri-operative care for patients undergoing elective colonic resection were collected in a prospective multi-centre study conducted between April 2005 and September 2006 to evaluate local and general morbidity.

Results

One thousand and forty-seven patients undergoing elective “fast-track” colonic resection were included. Compliance to essential parts of “fast-track” rehabilitation was high (epidural analgesia 86,6%, early oral feeding and mobilisation on the day of surgery 85.5 and 85.4%). Surgical morbidity was observed in 148 patients (14.1%) and general morbidity in 95 patients (9.1%), while mortality was 0.8%. Predefined discharge criteria were met within 5 (1–83) days after surgery, but because of economical restraints in the German DRG system, patients were discharged only after 8 (3–83) days. Re-admission rate was 3.9%.

Conclusion

“Fast-track” rehabilitation for elective colonic resection was safe and feasible in German hospitals of all sizes and yielded a low general morbidity and re-admission rate. Post-operative recovery was enhanced, but discharge from hospital was delayed because of economical reasons.

Keywords

Colonic resection Peri-operative treatment Multi-modal therapy Morbidity Hospital stay Fast-track