Abstract
Introduction
An accelerated multi-modal rehabilitation programme may improve the recuperation and reduce the complication rate in patients undergoing colorectal surgery. The aim of this study was to see whether fast-track recovery is feasible in various patient groups.
Patients and methods
Data on all patients operated for intestinal pathology from July 2006–April 2008 were prospectively collected for this prospective study. All included patients entered a multi-modal rehabilitation programme. Peri- and postoperative complications and readmissions, pathology reports and operation characteristics were recorded prospectively.
Results
Three hundred and forty-eight patients underwent colorectal surgery. No difference in readmission rate was found between various patient groups. The only significant differences after multivariate regression analysis were in re-operation rate and length of stay in favour of the elective surgery group.
Conclusions
Fast-track modalities can be introduced with a low complication rate in all patient groups. Length of stay in elderly patients averages 10 days, implying that this group cannot be considered as “fast track”, although the same protocol can also be applied in this group. Better organization of the aftercare might however considerably change the length of stay of elderly patients, since postoperative complications do not differ between old and young patients.
Similar content being viewed by others
References
Staib L, Link KH, Blatz A, Berger HG (2002) Surgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients—monoinstitutional experience. World J Surg 26:59–66
Kehlet H, Buchler MW, Beart RW, Williamson RP, Billingham 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
Wilmore DW, Kehlet H (2001) Recent advance: management of patients in fast track surgery. BMJ 322:473–476
Fearon KC, Ljungqvist O, Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477
Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57
Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–278
Basse L, Raskov HH, Hjort Jakobsen D et al (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmobary function and body composition. Br J Surg 89:446–453
Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928
Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641
Hjort jakobsen D, Sonne E, Basse L, Bisgaard T, Kehlet H (2002) Convalescence after colonic resection with fast-track versus conventional care. Scand J Surg 93:24–28
Wind J, Polle SW, Fung Kon Jin PHP et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809
Scharfenberg M, Raue W, Junghans T, Schwenk W (2007) “Fast-track” rehabilitation after colonic surgery in elderly patients—is it feasible? Int J Colorectal Dis 22:1469–1474
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 Rctum 46:851–859
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
Raue W, Haase O, Junghans T, Scharfenberg M, Muller JM, Schwenk W (2004) ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc 18:1463–1468
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
Gianotti L, Nespoli L, Torselli L, Panelli M, Nespoli A (2011) Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program. Int J Colorectal Dis 26(6):747–753
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Verheijen, P.M., vd Ven, A.W.H., Davids, P.H.P. et al. Feasibility of enhanced recovery programme in various patient groups. Int J Colorectal Dis 27, 507–511 (2012). https://doi.org/10.1007/s00384-011-1336-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-011-1336-z