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Fast-track surgery: procedure-specific aspects and future direction



Fast-track (FT) surgery can be defined as a coordinated perioperative approach aimed at reducing surgical stress and facilitating postoperative recovery. The objective of this review was to examine the literature on the procedure-specific application of FT surgery.


The concept of FT rehabilitation has been applied mainly in colorectal surgery, but positive data have appeared also in other areas such as orthopedic, hepatopancreaticobiliary, urological, upper gastrointestinal, gynecological, thoracic, vascular, endocrine, breast, and pediatric surgeries. There is very little experience with comprehensive FT programs in cardiac surgery or trauma. Quantitative analysis from randomized trials and cohort studies suggest that FT is effective in reducing hospital stay without increased adverse events. Other benefits of the FT approach include a reduction in complications, ileus, fatigue, pain, and hospital expenses. However, despite clear benefits of FT care, implementation in daily practice has been slow. Further efforts must be undertaken to secure implementation in routine clinical practice. Standardized FT protocols should be provided on a procedure-specific basis.

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  1. 1.

    Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617

  2. 2.

    Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86:227–230

  3. 3.

    Petersen MK, Madsen C, Andersen NT, Soballe K (2006) Efficacy of multimodal optimization of mobilization and nutrition in patients undergoing hip replacement: a randomized clinical trial. Acta Anaesthesiol Scand 50:712–717

  4. 4.

    Muehling B, Schelzig H, Steffen P, Meierhenrich R, Sunder-Plassmann L, Orend KH (2009) A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg 33:577–585

  5. 5.

    Munitiz V, Martinez-de-Haro LF, Ortiz A, Ruiz-de-Angulo D, Pastor P, Parrilla P (2010) Effectiveness of a written clinical pathway for enhanced recovery after transthoracic (Ivor Lewis) oesophagectomy. Br J Surg 97:714–718

  6. 6.

    Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R (1998) Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol 53:1209–1218

  7. 7.

    Morrell G (2001) Effect of structured preoperative teaching on anxiety levels of patients scheduled for cataract surgery. Insight 26:4–9

  8. 8.

    Zieren J, Menenakos C, Mueller JM (2007) Does an informative video before inguinal hernia surgical repair influence postoperative quality of life? Results of a prospective randomized study. Qual Life Res 16:725–729

  9. 9.

    Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198

  10. 10.

    Tonnesen H, Kehlet H (1999) Preoperative alcoholism and postoperative morbidity. Br J Surg 86:869–874

  11. 11.

    Tonnesen H, Rosenberg J, Nielsen HJ, Rasmussen V, Hauge C, Pedersen IK, Kehlet H (1999) Effect of preoperative abstinence on poor postoperative outcome in alcohol misusers: randomised controlled trial. BMJ 318:1311–1316

  12. 12.

    Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO (2011) Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med 124(144–154):e148

  13. 13.

    Guenaga KF, Matos D, Wille-Jorgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 9:CD001544

  14. 14.

    Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B, Portier G, Benoist S, Chipponi J, Vicaut E (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868

  15. 15.

    American Society of Anesthesiologists Committee (2011) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 114:495–511

  16. 16.

    Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH (2009) Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg 144:961–969

  17. 17.

    Carli F, Kehlet H, Baldini G, Steel A, McRae K, Slinger P, Hemmerling T, Salinas F, Neal JM (2011) Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med 36:63–72

  18. 18.

    Levy BF, Scott MJ, Fawcett W, Fry C, Rockall TA (2011) Randomized clinical trial of epidural, spinal or patient-controlled analgesia for patients undergoing laparoscopic colorectal surgery. Br J Surg 98:1068–1078

  19. 19.

    Baldini G, Carli F (2009) Anesthetic and adjunctive drugs for fast-track surgery. Curr Drug Targets 10:667–686

  20. 20.

    Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA (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

  21. 21.

    Bratzler DW, Houck PM (2004) Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 38:1706–1715

  22. 22.

    Wille-Jorgensen P, Rasmussen MS, Andersen BR, Borly L (2003) Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev:CD001217

  23. 23.

    White PF, Kehlet H, Neal JM, Schricker T, Carr DB, Carli F (2007) The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesth Analg 104:1380–1396, table of contents

  24. 24.

    Kehlet H (2008) Postoperative ileus—an update on preventive techniques. Nat Clin Pract Gastroenterol Hepatol 5:552–558

  25. 25.

    Lewis SJ, Andersen HK, Thomas S (2009) Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg 13:569–575

  26. 26.

    Petrowsky H, Demartines N, Rousson V, Clavien PA (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240:1074–1084, discussion 1084–1075

  27. 27.

    Gurusamy KS, Samraj K (2007) Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev:CD006003

  28. 28.

    Gurusamy KS, Samraj K, Mullerat P, Davidson BR (2007) Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev:CD006004

  29. 29.

    Wald HL, Ma A, Bratzler DW, Kramer AM (2008) Indwelling urinary catheter use in the postoperative period: analysis of the national surgical infection prevention project data. Arch Surg 143:551–557

  30. 30.

    Yang Z, Zheng Q, Wang Z (2008) Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. Br J Surg 95:809–816

  31. 31.

    Akhtar K, Bussen W, Scott SP (2009) Cancer stem cells—from initiation to elimination, how far have we reached? (review). Int J Oncol 34:1491–1503

  32. 32.

    Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793

  33. 33.

    Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504

  34. 34.

    Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (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

  35. 35.

    Gatt M, Anderson AD, Reddy BS, Hayward-Sampson P, Tring IC, MacFie J (2005) Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 92:1354–1362

  36. 36.

    Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA (2007) A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 245:867–872

  37. 37.

    Kuzma J (2008) Randomized clinical trial to compare the length of hospital stay and morbidity for early feeding with opioid-sparing analgesia versus traditional care after open appendectomy. Clin Nutr 27:694–699

  38. 38.

    Ionescu D, Iancu C, Ion D, Al-Hajjar N, Margarit S, Mocan L, Mocan T, Deac D, Bodea R, Vasian H (2009) Implementing fast-track protocol for colorectal surgery: a prospective randomized clinical trial. World J Surg 33:2433–2438

  39. 39.

    Muller S, Zalunardo MP, Hubner M, Clavien PA, Demartines N (2009) A fast-track program reduces complications and length of hospital stay after open colonic surgery. Gastroenterology 136:842–847

  40. 40.

    Serclova Z, Dytrych P, Marvan J, Nova K, Hankeova Z, Ryska O, Slegrova Z, Buresova L, Travnikova L, Antos F (2009) Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Clin Nutr 28:618–624

  41. 41.

    Wang G, Jiang ZW, Xu J, Gong JF, Bao Y, Xie LF, Li JS (2011) Fast-track rehabilitation program vs conventional care after colorectal resection: a randomized clinical trial. World J Gastroenterol 17:671–676

  42. 42.

    Kehlet H (2011) Fast-track surgery-an update on physiological care principles to enhance recovery. Langenbecks Arch Surg 396:585–590

  43. 43.

    Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423

  44. 44.

    Larsen K, Sorensen OG, Hansen TB, Thomsen PB, Soballe K (2008) Accelerated perioperative care and rehabilitation intervention for hip and knee replacement is effective: a randomized clinical trial involving 87 patients with 3 months of follow-up. Acta Orthop 79:149–159

  45. 45.

    Husted H, Hansen HC, Holm G, Bach-Dal C, Rud K, Andersen KL, Kehlet H (2010) What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark. Arch Orthop Trauma Surg 130:263–268

  46. 46.

    Andersen LO, Husted H, Otte KS, Kristensen BB, Kehlet H (2008) High-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Scand 52:1331–1335

  47. 47.

    Andersen LO, Otte KS, Husted H, Gaarn-Larsen L, Kristensen B, Kehlet H (2011) High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial. Acta Orthop 82:423-426

  48. 48.

    Ilfeld BM, Wright TW, Enneking FK, Vandenborne K (2006) Total elbow arthroplasty as an outpatient procedure using a continuous infraclavicular nerve block at home: a prospective case report. Reg Anesth Pain Med 31:172–176

  49. 49.

    Keulemans Y, Eshuis J, de Haes H, de Wit LT, Gouma DJ (1998) Laparoscopic cholecystectomy: day-care versus clinical observation. Ann Surg 228:734–740

  50. 50.

    Johansson M, Thune A, Nelvin L, Lundell L (2006) Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:40–45

  51. 51.

    Majeed AW, Troy G, Nicholl JP, Smythe A, Reed MW, Stoddard CJ, Peacock J, Johnson AG (1996) Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy. Lancet 347:989–994

  52. 52.

    Wichmann MW, Roth M, Jauch KW, Bruns CJ (2006) A prospective clinical feasibility study for multimodal “fast track” rehabilitation in elective pancreatic cancer surgery. Rozhl Chir 85:169–175

  53. 53.

    Kennedy EP, Rosato EL, Sauter PK, Rosenberg LM, Doria C, Marino IR, Chojnacki KA, Berger AC, Yeo CJ (2007) Initiation of a critical pathway for pancreaticoduodenectomy at an academic institution—the first step in multidisciplinary team building. J Am Coll Surg 204:917–923, discussion 923–914

  54. 54.

    Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce AA, Di Carlo V (2008) Fast-track recovery programme after pancreatico-duodenectomy reduces delayed gastric emptying. Br J Surg 95:1387–1393

  55. 55.

    Kennedy EP, Grenda TR, Sauter PK, Rosato EL, Chojnacki KA, Rosato FE Jr, Profeta BC, Doria C, Berger AC, Yeo CJ (2009) Implementation of a critical pathway for distal pancreatectomy at an academic institution. J Gastrointest Surg 13:938–944

  56. 56.

    van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, Fearon KC, Garden OJ, Dejong CH (2008) Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg 95:969–975

  57. 57.

    Stoot JH, van Dam RM, Busch OR, van Hillegersberg R, De Boer M, Olde Damink SW, Bemelmans MH, Dejong CH (2009) The effect of a multimodal fast-track programme on outcomes in laparoscopic liver surgery: a multicentre pilot study. HPB (Oxf) 11:140–144

  58. 58.

    Lin DX, Li X, Ye QW, Lin F, Li LL, Zhang QY (2011) Implementation of a fast-track clinical pathway decreases postoperative length of stay and hospital charges for liver resection. Cell Biochem Biophys 61:413-419

  59. 59.

    Gralla O, Haas F, Knoll N, Hadzidiakos D, Tullmann M, Romer A, Deger S, Ebeling V, Lein M, Wille A, Rehberg B, Loening SA, Roigas J (2007) Fast-track surgery in laparoscopic radical prostatectomy: basic principles. World J Urol 25:185–191

  60. 60.

    Recart A, Duchene D, White PF, Thomas T, Johnson DB, Cadeddu JA (2005) Efficacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 19:1165–1169

  61. 61.

    Koupparis A, Dunn J, Gillatt D, Rowe E (2010) Improvement of an enhanced recovery protocol for radical cystecomy. Br J Med Surg Urology 3:237–240

  62. 62.

    Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, Buerkle H, Harks A, Kehlet H (2001) Multimodal perioperative management—combining thoracic epidural analgesia, forced mobilization, and oral nutrition—reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anesth Analg 92:1594–1600

  63. 63.

    Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA (2008) Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int 101:698–701

  64. 64.

    Liu XX, Jiang ZW, Wang ZM, Li JS (2010) Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery. JPEN J Parenter Enter Nutr 34:313–321

  65. 65.

    Wang D, Kong Y, Zhong B, Zhou X, Zhou Y (2010) Fast-track surgery improves postoperative recovery in patients with gastric cancer: a randomized comparison with conventional postoperative care. J Gastrointest Surg 14:620–627

  66. 66.

    Brodner G, Pogatzki E, Van Aken H, Buerkle H, Goeters C, Schulzki C, Nottberg H, Mertes N (1998) A multimodal approach to control postoperative pathophysiology and rehabilitation in patients undergoing abdominothoracic esophagectomy. Anesth Analg 86:228–234

  67. 67.

    Ferri LE, Feldman LS, Stanbridge DD, Fried GM (2006) Patient perception of a clinical pathway for laparoscopic foregut surgery. J Gastrointest Surg 10:878–882

  68. 68.

    McCarty TM, Arnold DT, Lamont JP, Fisher TL, Kuhn JA (2005) Optimizing outcomes in bariatric surgery: outpatient laparoscopic gastric bypass. Ann Surg 242:494–498, discussion 498–501

  69. 69.

    Bergland A, Gislason H, Raeder J (2008) Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases. Acta Anaesthesiol Scand 52:1394–1399

  70. 70.

    Marx C, Rasmussen T, Jakobsen DH, Ottosen C, Lundvall L, Ottesen B, Callesen T, Kehlet H (2006) The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy. Acta Obstet Gynecol Scand 85:488–492

  71. 71.

    Ottesen M, Sorensen M, Rasmussen Y, Smidt-Jensen S, Kehlet H, Ottesen B (2002) Fast track vaginal surgery. Acta Obstet Gynecol Scand 81:138–146

  72. 72.

    Ottesen M, Sorensen M, Kehlet H, Ottesen B (2003) Short convalescence after vaginal prolapse surgery. Acta Obstet Gynecol Scand 82:359–366

  73. 73.

    Sjetne IS, Krogstad U, Odegard S, Engh ME (2009) Improving quality by introducing enhanced recovery after surgery in a gynaecological department: consequences for ward nursing practice. Qual Saf Health Care 18:236–240

  74. 74.

    Muehling BM, Halter GL, Schelzig H, Meierhenrich R, Steffen P, Sunder-Plassmann L, Orend KH (2008) Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg 34:174–180

  75. 75.

    Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred consecutive minimally invasive parathyroid explorations. Ann Surg 232:331–339

  76. 76.

    Cohen MS, Finkelstein SE, Brunt LM, Haberfeld E, Kangrga I, Moley JF, Lairmore TC (2005) Outpatient minimally invasive parathyroidectomy using local/regional anesthesia: a safe and effective operative approach for selected patients. Surgery 138:681–687, discussion 687–689

  77. 77.

    Rayan SS, Hodin RA (2000) Short-stay laparoscopic adrenalectomy. Surg Endosc 14:568–572

  78. 78.

    Edwin B, Raeder I, Trondsen E, Kaaresen R, Buanes T (2001) Outpatient laparoscopic adrenalectomy in patients with Conn's syndrome. Surg Endosc 15:589–591

  79. 79.

    D'Hubert E, Proske JM (2010) How to optimize the economic viability of thyroid surgery in a French public hospital? J Visc Surg 147:e259–e263

  80. 80.

    Coveney E, Weltz CR, Greengrass R, Iglehart JD, Leight GS, Steele SM, Lyerly HK (1998) Use of paravertebral block anesthesia in the surgical management of breast cancer: experience in 156 cases. Ann Surg 227:496–501

  81. 81.

    Dooley WC (2002) Ambulatory mastectomy. Am J Surg 184:545–548, discussion 548–549

  82. 82.

    Reismann M, von Kampen M, Laupichler B, Suempelmann R, Schmidt AI, Ure BM (2007) Fast-track surgery in infants and children. J Pediatr Surg 42:234–238

  83. 83.

    Reismann M, Dingemann J, Wolters M, Laupichler B, Suempelmann R, Ure BM (2009) Fast-track concepts in routine pediatric surgery: a prospective study in 436 infants and children. Langenbecks Arch Surg 394:529–533

  84. 84.

    Grewal H, Sweat J, Vazquez WD (2004) Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery. JSLS 8:151–154

  85. 85.

    Mattioli G, Palomba L, Avanzini S, Rapuzzi G, Guida E, Costanzo S, Rossi V, Basile A, Tamburini S, Callegari M, DellaRocca M, Disma N, Mameli L, Montobbio G, Jasonni V (2009) Fast-track surgery of the colon in children. J Laparoendosc Adv Surg Tech A 19 (Suppl 1):S7–S9

  86. 86.

    Lassen K, Hannemann P, Ljungqvist O, Fearon K, Dejong CH, von Meyenfeldt MF, Hausel J, Nygren J, Andersen J, Revhaug A (2005) Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries. BMJ 330:1420–1421

  87. 87.

    Hannemann P, Lassen K, Hausel J, Nimmo S, Ljungqvist O, Nygren J, Soop M, Fearon K, Andersen J, Revhaug A, von Meyenfeldt MF, Dejong CH, Spies C (2006) Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries. Acta Anaesthesiol Scand 50:1152–1160

  88. 88.

    Kehlet H, Buchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54

  89. 89.

    Walter CJ, Smith A, Guillou P (2006) Perceptions of the application of fast-track surgical principles by general surgeons. Ann R Coll Surg Engl 88:191–195

  90. 90.

    Hasenberg T, Keese M, Langle F, Reibenwein B, Schindler K, Herold A, Beck G, Post S, Jauch KW, Spies C, Schwenk W, Shang E (2009) ‘Fast-track’ colonic surgery in Austria and Germany—results from the survey on patterns in current perioperative practice. Colorectal Dis 11:162–167

  91. 91.

    Delaney CP, Senagore AJ, Gerkin TM, Beard TL, Zingaro WM, Tomaszewski KJ, Walton LK, Poston SA (2010) Association of surgical care practices with length of stay and use of clinical protocols after elective bowel resection: results of a national survey. Am J Surg 199:299–304, discussion 304

  92. 92.

    Srinivasa S, Sammour T, Kahokehr A, Hill AG (2010) Enhanced Recovery After Surgery (ERAS) protocols must be considered when determining optimal perioperative care in colorectal surgery. Ann Surg 252:409, author reply 409–410

  93. 93.

    Kahokehr A, Robertson P, Sammour T, Soop M, Hill AG (2011) Perioperative care: a survey of New Zealand and Australian colorectal surgeons. Color Dis 13:1308–1313

  94. 94.

    Pozzi G, Falcone A, Sabbatino F, Solej M, Nano M (2012) “Fast track surgery” in the north-west of Italy: influence on the orientation of surgical practice. Updates Surg 64:131-144

  95. 95.

    Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP (2011) Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 149:830–840

  96. 96.

    Kehlet H (2011) Surgery: fast-track colonic surgery and the ‘knowing-doing’ gap. Nat Rev Gastroenterol Hepatol 8:539–540

  97. 97.

    Schwenk W (2012) Fast-track: evaluation of a new concept. Chirurg 83:351–355

  98. 98.

    Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 146:571–577

  99. 99.

    Kosar S, Seelen HA, Hemmen B, Evers SM, Brink PR (2009) Cost-effectiveness of an integrated ‘fast track’ rehabilitation service for multi-trauma patients involving dedicated early rehabilitation intervention programs: design of a prospective, multi-centre, non-randomised clinical trial. J Trauma Manag Outcomes 3:1

  100. 100.

    Hendry PO, van Dam RM, Bukkems SF, McKeown DW, Parks RW, Preston T, Dejong CH, Garden OJ, Fearon KC (2010) Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. Br J Surg 97:1198–1206

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The authors are grateful to Professor Henrik Kehlet (Rigshospitalet, Denmark) for reviewing the manuscript and providing helpful comments.

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Correspondence to Roland Andersson.

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Ansari, D., Gianotti, L., Schröder, J. et al. Fast-track surgery: procedure-specific aspects and future direction. Langenbecks Arch Surg 398, 29–37 (2013).

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  • Fast-track surgery
  • Enhanced recovery after surgery
  • ERAS
  • Perioperative care
  • Implementation
  • Evidence-based medicine