Skip to main content

Advertisement

SpringerLink
Log in

“Fast-track” rehabilitation for elective colonic surgery in Germany—prospective observational data from a multi-centre quality assurance programme

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The results of “Fast-track” colonic surgery in an unselected population outside of specialised units has been unknown yet.

Materials and methods

Data from 24 German hospitals performing “Fast-track” rehabilitation as the standard peri-operative care for patients undergoing elective colonic resection were collected in a prospective multi-centre study conducted between April 2005 and September 2006 to evaluate local and general morbidity.

Results

One thousand and forty-seven patients undergoing elective “fast-track” colonic resection were included. Compliance to essential parts of “fast-track” rehabilitation was high (epidural analgesia 86,6%, early oral feeding and mobilisation on the day of surgery 85.5 and 85.4%). Surgical morbidity was observed in 148 patients (14.1%) and general morbidity in 95 patients (9.1%), while mortality was 0.8%. Predefined discharge criteria were met within 5 (1–83) days after surgery, but because of economical restraints in the German DRG system, patients were discharged only after 8 (3–83) days. Re-admission rate was 3.9%.

Conclusion

“Fast-track” rehabilitation for elective colonic resection was safe and feasible in German hospitals of all sizes and yielded a low general morbidity and re-admission rate. Post-operative recovery was enhanced, but discharge from hospital was delayed because of economical reasons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bardram L, Funch Jensen P, Jensen P, Crawford ME, Kehlet H (1995) Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilisation. Lancet 345(8952):763–764

    Article  PubMed  CAS  Google Scholar 

  2. Fearon KC, Ljungqvist O, Von MM, Revhaug A, Dejong CH, Lassen K et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24(3):466–477

    Article  PubMed  CAS  Google Scholar 

  3. Schwenk W, Raue W, Haase O, Junghans T, Muller JM (2004) “Fast-track” colonic surgery—first experience with a clinical procedure for accelerating postoperative recovery. Chirurg 75(5):508–514

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. Stephen A, Berger D (2003) Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical car pathway after elective colon resection. Surgery 133:277–282

    Article  PubMed  Google Scholar 

  6. Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT et al (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93(7):800–809

    Article  PubMed  CAS  Google Scholar 

  7. Marusch F, Koch A, Schmidt U, Zippel R, Lehmann M, Czarnetzki HD et al (2001) Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study. Int J Colorectal Dis 16(6):362–369

    Article  PubMed  CAS  Google Scholar 

  8. Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP et al (2001) Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results. Surg Endosc 15(2):116–120

    Article  PubMed  CAS  Google Scholar 

  9. Pessaux P, Muscari F, Ouellet JF, Msika S, Hay JM, Millat B et al (2004) Risk factors for mortality and morbidity after elective sigmoid resection for diverticulitis: prospective multicenter multivariate analysis of 582 patients. World J Surg 28(1):92–96

    Article  PubMed  Google Scholar 

  10. Marusch F, Koch A, Schmidt U, Steinert R, Ueberrueck T, Bittner R et al (2005) The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma and its significance for perioperative management. World J Surg 29(8):1013–1021

    Article  PubMed  Google Scholar 

  11. Itani KM, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA (2006) Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med 355(25):2640–2651

    Article  PubMed  CAS  Google Scholar 

  12. Kehlet H, Büchler MW, Beart RW, Billingham RPWR (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

    Article  PubMed  Google Scholar 

  13. Schwenk W, Gunther N, Haase O, Konschake U, Muller JM (2003) Wandel der perioperativen Therapie bei elektiven kolorektalen Resektionen in Deutschland 1991 und 2001/2002. [Changes in perioperative treatment for elective colorectal resections in Germany 1991 and 2001/2002]. Zentralbl Chir 128(12):1086–1092

    Article  PubMed  CAS  Google Scholar 

  14. Diagnosis-related Groups in Germany. G-DRG Website. http://www.g-drg.de/

  15. Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Barlehner E et al (2004) Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective, multicenter study on 1,545 patients. Dis Colon Rectum 47(11):1883–1888

    Article  PubMed  Google Scholar 

  16. Anderson ADG, Mc Naught 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 

  17. Basse L, Hjort JD, Billesbolle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232(1):51–57

    Article  PubMed  CAS  Google Scholar 

  18. Basse L, Thorbol J, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47:271–278

    Article  PubMed  Google Scholar 

  19. Zutshi M, Delaney CP, Senagore AJ, Mekhail N, Lewis B, Connor JT et al (2005) Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. Am J Surg 189(3):268–272

    Article  PubMed  Google Scholar 

  20. Guyatt G, Gutterman D, Baumann MH, Drizzo-Harris D, Hylek EM, Phillips B et al (2006) Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American college of chest physicians task force. Chest 129(1):174–181

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

Data collection within the Quality Assurance Program “Fast-track” Colon II was funded (in alphabetical order) by: Astra Zeneca Germany, Fresenius Germany, Karl Storz Endoskope Germany, Pfizer Germany, Pfrimmer/Nutricia Germany and Tyco Healthcare Germany.

Author information

Authors and Affiliations

  1. General-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    W. Schwenk, N. Günther & T. Junghans

  2. Chirurgische Klinik I, Krankenhaus Bad Soden, Kliniken des Main-Taunus-Kreises GmbH, Bad Soden, Germany

    P. Wendling

  3. Klinik für Allgemein- und Viszeralchirurgie, Westpfalz-Klinikum GmbH Standort III Kirchheimbolanden, Kirchheimbolanden, Germany

    M. Schmid

  4. Klinik für Allgemein- und Viszeralchirurgie, Ammerland Klinik GmbH, Westerstede, Germany

    W. Probst

  5. Klinik für Allgemein- und Viszeralchirurgie, Sankt-Marien Hospital, Mülheim an der Ruhr, Germany

    K. Kipfmüller

  6. Klinik für Allgemein- und Viszeralchirurgie, Diakoniekrankenhaus Mannheim, Mannheim, Germany

    B. Rumstadt

  7. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Klinikum Essen Mitte, Essen, Germany

    M. K. Walz

  8. Chirurgische Klinik I Allgemein-, Viszeral- und Gefäßchirurgie, Klinikum Aschaffenburg, Aschaffenburg, Germany

    R. Engemann

Authors
  1. W. Schwenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Günther
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Wendling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Probst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Kipfmüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. Rumstadt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. K. Walz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Engemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. T. Junghans
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

“Fast-track” Colon II Quality Assurance Group

Corresponding author

Correspondence to W. Schwenk.

Additional information

A complete list of all centres contributing patients to the “Fast-track” Colon II-Quality Assurance programme is given at the end of the manuscript.

Appendix

Appendix

Addendum

The following surgeons and hospitals participated in the “Fast-track” Colon II registry by providing at least one patient:

  1. 1.

    P. Wendling, Kliniken des Main-Taunus-Kreises GmbH, Krankenhaus Bad Soden

  2. 2.

    R. Engemann, Klinikum Aschaffenburg

  3. 3.

    M. Schmid, Westpfalz-Klinikum GmbH Standort III Kirchheimbolanden

  4. 4.

    W. Probst, Ammerland Klinik GmbH, Westerstede

  5. 5.

    K. Kipfmüller, Sankt-Marien Hospital, Mühlheim an der Ruhr

  6. 6.

    J. M. Müller Charité Campus Mitte, Berlin

  7. 7.

    B. Rumstadt, Diakoniekrankenhaus, Mannheim

  8. 8.

    M. K. Walz, Klinikum Essen Mitte, Essen

  9. 9.

    K. Nagel, Marienhospital, Aachen

  10. 10.

    J. Gönninger, Klinikum Minden

  11. 11.

    K. Schönleben, Klinikum der Stadt Ludwigshafen

  12. 12.

    B. Vetter, St. Elisabeth-Krankenhaus, Lörrach

  13. 13.

    H.-P. Meyer, Hunsrück Klinik Kreuznacher Diakonie, Simmern

  14. 14.

    B. Rehnisch, Klinikum des Landkreises Löbau-Zittau gGmbH, Zittau

  15. 15.

    H.-W. Krawzak, Klinikum Niederberg, Velbert

  16. 16.

    C.-T. Germer, Klinikum Nürnberg

  17. 17.

    A. Hirner, Universitätsklinikum Bonn

  18. 18.

    M. Varney, Städtisches Klinikum Gütersloh

  19. 19.

    D. Ockert, Krankenhaus der Barmherzigen Brüder, Trier

  20. 20.

    V. Paolucci, Ketteler Krankenhaus, Offenbach

  21. 21.

    M. Kahle, St. Elisabeth-Krankenhaus, Bad Kissingen

  22. 22.

    A. Trupka, Klinikum Starnberg

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schwenk, W., Günther, N., Wendling, P. et al. “Fast-track” rehabilitation for elective colonic surgery in Germany—prospective observational data from a multi-centre quality assurance programme. Int J Colorectal Dis 23, 93–99 (2008). https://doi.org/10.1007/s00384-007-0374-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-007-0374-z

Keywords

Search

Navigation