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

Abstract

Introduction

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.

Discussion

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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Acknowledgments

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

Conflicts of interest

None.

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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). https://doi.org/10.1007/s00423-012-1006-9

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Keywords

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