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Insights into fast-track colon surgery: a plea for a tailored program

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Abstract

Background

This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay.

Design

This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression.

Results

Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001).

Conclusions

The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.

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Acknowledgments

The authors thank the whole “Fast-Track” team of the St-Luc Hospital in Brussels for their invaluable assistance and Prof. C. Craddock-de Burbure for revising the manuscript.

Disclosures

Drs. Luca Pellegrino, Fernande Lois, Christophe Remue, Patrice Forget, Brigitte Crispin, Daniel Leonard, Jacques Jamart, and Alex Kartheuser have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, St-Luc University Hospital, Université Catholique de Louvain (UCL), 10 Avenue Hippocrate, 1200, Brussels, Belgium

    L. Pellegrino, C. Remue, B. Crispin, D. Leonard & A. Kartheuser

  2. Department of Anaesthesiology, St-Luc University Hospital, Université Catholique de Louvain (UCL), 10 Avenue Hippocrate, 1200, Brussels, Belgium

    F. Lois & P. Forget

  3. Department of Biostatistics, Cliniques Universitaires Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium

    J. Jamart

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  1. L. Pellegrino
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  2. F. Lois
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  3. C. Remue
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  4. P. Forget
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  8. A. Kartheuser
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Corresponding author

Correspondence to A. Kartheuser.

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Pellegrino, L., Lois, F., Remue, C. et al. Insights into fast-track colon surgery: a plea for a tailored program. Surg Endosc 27, 1178–1185 (2013). https://doi.org/10.1007/s00464-012-2572-1

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  • DOI: https://doi.org/10.1007/s00464-012-2572-1

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