Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition.
BACKGROUND
Postoperative organ dysfunction contributes to morbidity, hospital stay and convalescence. Multimodal rehabilitation with epidural analgesia, early oral feeding, mobilization and laxative use after colonic resection has reduced ileus and hospital stay.


METHODS
Fourteen patients receiving conventional care (group 1) and 14 patients who had multimodal rehabilitation (group 2) were studied before and 8 days after colonic resection. Outcome measures included postoperative mobilization, body composition by whole-body dual X-ray absorptiometry, cardiovascular response to treadmill exercise, pulmonary function and nocturnal oxygen saturation.


RESULTS
Defaecation occurred earlier (median day 1 versus day 4) and hospital stay was shorter (median 2 versus 12 days) in patients who had multimodal treatment. Lean body and fat mass decreased in group 1 but not in group 2. Exercise performance decreased by 44 per cent in group 1 but was unchanged in group 2. A postoperative increase in heart rate (HR) response to exercise was avoided in group 2. Pulmonary function decreased in group 1 but not in group 2. There was less nocturnal postoperative hypoxaemia in group 2. Cardiac demand-supply (HR/oxygen saturation ratio) increased in group 1 but not in group 2.


CONCLUSIONS
Multimodal rehabilitation prevents reduction in lean body mass, pulmonary function, oxygenation and cardiovascular response to exercise after colonic surgery.
Basse
L
L
Department of Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark.
Raskov
H H
HH
Hjort Jakobsen
D
D
Sonne
E
E
Billesbølle
P
P
Hendel
H W
HW
Rosenberg
J
J
Kehlet
H
H
D000368:Aged; D001823:Body Composition; D002097:C-Reactive Protein / Q000032:analysis; D003108:Colonic Diseases / Q000601:surgery*; D004434:Early Ambulation; D017079:Exercise Tolerance; D005221:Fatigue / Q000209:etiology; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010101:Oxygen Consumption; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis; D014797:Vital Capacity / Q000502:physiology
D012709:Serum Albumin; D002097:C-Reactive Protein