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Fast-Track Concepts in Major Open Upper Abdominal and Thoracoabdominal Surgery: A Review

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Abstract

Introduction

The purpose of this article was to review the research considering fast-track concepts in upper abdominal and thoracoabdominal surgery.

Methods

A search for clinical studies evaluating the fast-track concept after open major upper abdominal or thoracoabdominal surgery was performed. Reference lists of identified articles were searched. Trials—written in English—that compared a concept and traditional care were evaluated with regard to their internal validity. Level of evidence was defined and each outcome was evaluated.

Results

In total, 15 articles were found, separated into gastric (n = 2), pancreatic (n = 5), hepatic (n = 2), esophageal (n = 3), and aortic surgery (n = 3). Three were randomized, controlled trials. The different trials represented various concepts of fast-track surgery, but the majority included specific programs for analgesics, avoidance of drainage tubes, early start of oral nutrition, and early and active mobilization. There is moderate evidence that fast-track concepts result in shorter hospital stay. There is low evidence that fast-track concepts shorten need of ventilation, decrease the need of care at the intensive care unit, decrease postoperative pain, and reduce total hospital costs. The concepts seem to have similar rates of surgical complications, readmission rate, and mortality rates as conventional care. No specific adverse events were reported.

Conclusions

Although the methodological quality of the articles reviewed was low and the trials heterogeneous, all trials concluded that the introduction of fast-track concepts were safe and feasible, achieved shorter hospital stays, and reduced costs. Future randomized, controlled trials are needed to further evaluate the effect of these concepts.

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Conflicts of interest

The work with this article was carried out without any grant support. There are no potential and real conflicts of interest concerning the content in this article.

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Authors and Affiliations

  1. Department of Physical Therapy, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden

    Monika Fagevik Olsén

  2. Department of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University, P.O. Box 455, 405 30, Göteborg, Sweden

    Monika Fagevik Olsén

  3. Department of Anesthesia, Surgery and Intensive Care, Kungälvs Hospital, 442 83, Kungälv, Sweden

    Elisabet Wennberg

  4. Department of Clinical Science/Anesthesia and Intensive Care, Sahlgrenska Academy, Gothenburg University, 413 45, Gothenburg, Sweden

    Elisabet Wennberg

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  1. Monika Fagevik Olsén
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  2. Elisabet Wennberg
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Correspondence to Monika Fagevik Olsén.

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Fagevik Olsén, M., Wennberg, E. Fast-Track Concepts in Major Open Upper Abdominal and Thoracoabdominal Surgery: A Review. World J Surg 35, 2586–2593 (2011). https://doi.org/10.1007/s00268-011-1241-1

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  • DOI: https://doi.org/10.1007/s00268-011-1241-1

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