International Journal of Colorectal Disease

, Volume 24, Issue 10, pp 1119–1131

Fast-track vs standard care in colorectal surgery: a meta-analysis update

  • Nikolaos Gouvas
  • Emile Tan
  • Alistair Windsor
  • Evaghelos Xynos
  • Paris P. Tekkis
Review

DOI: 10.1007/s00384-009-0703-5

Cite this article as:
Gouvas, N., Tan, E., Windsor, A. et al. Int J Colorectal Dis (2009) 24: 1119. doi:10.1007/s00384-009-0703-5
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Abstract

Background

Fast-track (FT) protocols accelerate patient's recovery and shorten hospital stay as a result of the optimization of the perioperative care they offer. The aim of this review is to examine the latest evidence for fast-track protocols when compared with standard care in elective colorectal surgery involving segmental colonic and/or rectal resection.

Materials and methods

All randomized controlled trials and controlled clinical trials on FT colorectal surgery were reviewed systematically. The main end points were short-term morbidity, length of primary postoperative hospital stay, length of total postoperative stay, readmission rate, and mortality. Quality assessment and data extraction were performed independently by two observers.

Results

Eleven studies were eligible for analysis (four randomized controlled trials (RCTs) and seven controlled clinical trials (CCT)), including 1,021 patients. Primary hospital stay (weighted mean difference −2.35 days, 95% confidence interval (CI) −3.24 to −1.46 days, P < 0.00001) and total hospital stay (weighted mean difference −2.46 days, 95% CI −3.43 to −1.48 days, P < 0.00001) were significantly lower for FT programs. Morbidity was also lower in the FT group. Readmission rates were not significantly different. No increase in mortality was found.

Conclusions

FT protocols show high-level evidence on reducing primary and total hospital stay without compromising patients' safety offering lower morbidity and the same readmission rates. Enhanced recovery programs should become a mainstay of elective colorectal surgery.

Keywords

Fast-track protocols Enhanced recovery programs Meta-analysis Colorectal surgery 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Nikolaos Gouvas
    • 1
    • 2
  • Emile Tan
    • 1
  • Alistair Windsor
    • 3
  • Evaghelos Xynos
    • 2
  • Paris P. Tekkis
    • 1
  1. 1.Department of Biosurgery and Surgical Technology, Imperial CollegeSt. Mary’s HospitalLondonUK
  2. 2.Medical SchoolUniversity of CreteHeraklionGreece
  3. 3.Department of Colorectal SurgeryUniversity College HospitalLondonUK

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