Zusammenfassung
Der Begriff „Fast-Track-Rehabilitation“ bezeichnet die Kombination verschiedener perioperativer evidenzbasierter Maßnahmen zu einem interdisziplinären perioperativen Behandlungspfad. Das primäre Ziel der Fast-Track-Rehabilitation ist es, die Organfunktionen nach einem operativen Eingriff zu optimieren und so allgemeine postoperative Komplikationen zu vermeiden. Gleichzeitig führen diese Maßnahmen zu einer rascheren Rekonvaleszenz der Patienten, sodass diese wesentlich früher als unter traditioneller Behandlung aus dem Krankenhaus verlegt werden können. In der vorliegenden Arbeit werden die persönlichen Erfahrungen des Autors in der Etablierung der Fast-Track-Rehabilitation bei elektiven Kolonresektionen dargestellt, der aktuelle Stand der wissenschaftlichen Evaluation dieses Konzeptes zusammengefasst und die Probleme bei der Umsetzung im klinischen Alltag diskutiert.
Abstract
The term fast-track describes the combination of several perioperative evidence-based measures to form a clinical pathway. The primary aim of fast-track is to optimize organ function after surgery in order to avoid general morbidity. At the same time patient recovery is dramatically enhanced and discharge from hospital is possible much earlier than with traditional perioperative care. This article describes the author’s experience in implementing a fast-track program for elective colonic resection. It shows the current status of scientific evaluation of the fast-track concept and discusses typical obstacles during introduction of fast-track into the clinical routine in Germany.
Literatur
Adamina MH, Kehlet GA, Tomlinson AJ et al (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840
Andersen J, Hjort-Jakobsen D, Christiansen PS, Kehlet H (2007) Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br J Surg 94:890–893
Anderson ADG, McNaught CE, Macfie J et al (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504
Bardram L, Funch-Jensen P, Jensen P et al (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345:763–764
Basse L, Hjort Jakobsen D, Billesbolle P et al (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57
Basse L, Raskov HH, Hjort JD, Sonne E et al (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89:446–453
Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277
Braumann C, Guenther N, Wendling P et al (2009) Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program „Fast-Track Colon II“. Dig Surg 26:123–129
Delaney CP, Zutshi M, Senagore AJ et al (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859
Gatt M, Anderson AD, Reddy BS et al (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92:1354–1362
Gouvas N, Tan E, Windsor A et al (2009) Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24:1119–1131
Ionescu D, Iancu C, Ion D et al (2009) Implementing fast-track protocol for colorectal surgery: a prospective randomized clinical trial. World J Surg 33:2433–2438
Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86:227–230
Khoo CK, Vickery CJ, Forsyth N et al (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872
Muller S, Zalunardo MP, Hubner M et al (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842–847
Rumstadt B, Guenther N, Wendling P et al (2009) Multimodal perioperative rehabilitation for colonic surgery in the elderly. World J Surg 33:1757–1763
Schwenk W (2009) Fast track rehabilitation in visceral surgery. Chirurg 80:690–701
Schwenk W, Gunther N, Wendling P et al (2008) „Fast-track“ rehabilitation for elective colonic surgery in Germany–prospective observational data from a multi-centre quality assurance programme. Int J Colorectal Dis 23:93–99
Schwenk W, Raue W, Haase O et al (2004) „Fast-track“ colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery. Chirurg 75:508–514
Serclova Z, Dytrych P, Marvan J et al (2009) Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Clin Nutr 28:618–624
Tsilimparis N, Haase O, Wendling P et al (2010) Laparoscopic „fast-track“ sigmoidectomy for diverticulitis disease in Germany. Results of a prospective quality assurance program. Dtsch Med Wochenschr 135:1743–1748
Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875
Wind J, Polle SW, Fung Kon Jin PH et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Additional information
Der persönliche Dank des Autors gilt Herrn Professor Dr. med. Joachim M. Müller, der die Erprobung des Fast-Track-Konzeptes in der Klinik in Deutschland erstmals ermöglicht hat.
Rights and permissions
About this article
Cite this article
Schwenk, W. Fast-Track: Evaluation eines neuen Konzeptes. Chirurg 83, 351–355 (2012). https://doi.org/10.1007/s00104-011-2226-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00104-011-2226-1