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Implementing Fast-Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial

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Abstract

Background

Fast-track protocols are followed by an enhanced recovery, early return to bowel function and to complete nutrition, and a reduced hospital stay. Our study was designed to implement fast-track protocol in our university hospital.

Methods

The 96 consecutive patients with colorectal neoplasm included in the study were randomized in two equal groups: group 1 (FT) included patients undergoing colorectal surgery in a fast-track protocol, and group 2 (C) included patients undergoing colorectal surgery with a conventional care protocol. As with other fast-track protocols, our protocol included carbohydrate fluids load before operation, early mobilization and oral feeding, regular prokinetics, and multimodal postoperative analgesia. Time to restoration of bowel function, to complete mobilization and feeding, length of hospital stay, and incidence of complications and readmissions were monitored.

Results

Time to mobilization, restoring of bowel function, and complete oral feeding were significantly shorter with fast-track protocol (p = 0.001, p = 0.042, and p = 0.01, respectively). Hospital stay also was shorter in the fast-track group (p = 0.001). The incidence of complications did not significantly differ with the study groups.

Conclusions

In our study, fast-track protocol resulted in a shorter time to mobilization, complete feeding, and discharge from hospital. Fast-track protocol did not increase the incidence of complications. However, we consider that our data require further confirmation with powered multicenter national studies.

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References

  1. Kehlet TH, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641

    Article  PubMed  Google Scholar 

  2. Basse L, Raskov HH, Hjort Jakobsen D et al (2002) Accelerated postoperative recovery program after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg 89:446–453

    Article  PubMed  CAS  Google Scholar 

  3. Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–277

    Article  PubMed  Google Scholar 

  4. Jakobsen DH, Sonne E, Andreasen J, Kehlet TH (2006) Convalescence after colonic surgery with fast-track vs conventional care. Colorectal Dis 8:683–687

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  CAS  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. Wind J, Hofland J, Preckel B et al (2006) Perioperative strategy in colonic surgery: laparoscopy and/or fast-track multimodal management versus standard care (LAFA trial). BMC Surg 6:16. doi:10.1186/1471-2482-6-16

    Article  PubMed  Google Scholar 

  8. Nygren J, Hausel J, Kehlet H et al (2005) A comparison in five European Centres of case mix clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr 24:455–461

    Article  PubMed  Google Scholar 

  9. Wilmore DW, Kehlet H (2001) Management of patients in fast-track surgery. BMJ 322:473–476

    Article  PubMed  CAS  Google Scholar 

  10. Lassen K, Nygren J, Hausel J, Soop M, Andersen J, Kehlet H (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477

    Article  PubMed  Google Scholar 

  11. Junghans T, Junghans E, Schwenk W (2007) Results of fast-track rehabilitation in elective colonic surgery. Transfus Altern Transfus Med 9:78–84

    Article  Google Scholar 

  12. Junger M, Herman N, Schoenberg M (2007) Postoperative care in fast-track rehabilitation for elective colonic surgery. Transfus Altern Transfus Med 9:66–77

    Article  Google Scholar 

  13. Scharfenberg M, Rave 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

    Article  PubMed  CAS  Google Scholar 

  14. Basse L, Hijor T, Jakobsen D, Billesbolle P et al (2000) A clinical pathway to accelerate recovery after colonic resection. Am J Surg 232:51–57

    CAS  Google Scholar 

  15. Wichmann M, Eben R, Angele M, Braundenburg F, Goetz A, Jaunch KW (2007) Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical imunological single centre study. ANZ J Surg 77:502–507

    Article  PubMed  Google Scholar 

  16. Gatt M, Anderson ADG, 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

    Article  PubMed  CAS  Google Scholar 

  17. Raue W, Hasse O, Junghans T, Scarfenberg M, Muller JM, Schwenk W (2004) Fast-track multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy. Surg Endosc 18:1463–1468

    Article  PubMed  CAS  Google Scholar 

  18. Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halwerson AL, Renzi FH (2001) Fast-track postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538

    Article  PubMed  CAS  Google Scholar 

  19. Mythen M (2005) Postoperative gastrointestinal tract dysfunction. Anesth Analg 100:196–204

    Article  PubMed  Google Scholar 

  20. Kehlet H (2006) Future perspectives and research initiatives in fast-track surgery. Langenbeck’s Arch Surg 391:495–498

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 134(8):657–662

    PubMed  CAS  Google Scholar 

  23. Altman DG, Schulz KF, Moher D, Egger M. Davidoff F, Elbourne D, Gøtzsche PC, Lang T. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001;134(8):663–694

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Iuliu Hatieganu, Cluj-Napoca, Romania

    Daniela Ionescu & Simona Margarit

  2. Department of Surgery, University of Medicine and Pharmacy, Iuliu Hatieganu, Cluj-Napoca, Romania

    Cornel Iancu & Nadim Al-Hajjar

  3. Department of Physiology, University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania

    Daniela Ion

  4. Registrars in Surgery, Clinical Hospital O. Fodor, Cluj-Napoca, Romania

    Lucian Mocan & Raluca Bodea

  5. Registrars in Anesthesia, Clinical Hospital O. Fodor, Cluj-Napoca, Romania

    Delia Deac & Horatiu Vasian

  6. Department of Physiology, University of Medicine and Pharmacy, Iuliu Hatieganu, Cluj-Napoca, Romania

    Teodora Mocan

Authors
  1. Daniela Ionescu
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  2. Cornel Iancu
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  3. Daniela Ion
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  4. Nadim Al-Hajjar
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  5. Simona Margarit
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  6. Lucian Mocan
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  7. Teodora Mocan
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  8. Delia Deac
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  9. Raluca Bodea
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  10. Horatiu Vasian
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Corresponding author

Correspondence to Daniela Ionescu.

Additional information

Addendum

Authors’ involvement in the study:

C. Iancu, N. Al-Hajjar—senior surgeons operating all the patients included in the study

D. Ionescu, S. Margarit—senior anesthetists involved in anesthesia for the patients included in the study

L. Mocan, R. Bodea—registrars in surgery, part of the surgical team, involved in postoperative surgical follow-up

D. Deac, H. Vasian—registrars in anesthesia, part of the anesthetic team, involved in postoperative anesthetic follow-up

D. Ion—patients’ randomization, patients’ database

T. Mocan—patients’ database, medical statistics

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Ionescu, D., Iancu, C., Ion, D. et al. Implementing Fast-Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial. World J Surg 33, 2433–2438 (2009). https://doi.org/10.1007/s00268-009-0197-x

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  • DOI: https://doi.org/10.1007/s00268-009-0197-x

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