["Fast-track" colonic surgery-first experience with a clinical procedure for accelerating postoperative recovery].
OBJECTIVE
The aim of multimodal perioperative treatment concepts is to lower the extent of general complications after elective colonic resection and "traditional" perioperative therapy and to allow hospital discharge only a few days following the operation.


METHODS
In this prospective study, we examined a new perioperative treatment plan for accelerating postoperative recovery and evaluated the results. This so-called "fast-track" program employs combined thoracal peridural analgesia, forced mobilization, and rapid renourishment within the clinic.


RESULTS
Sixty-four consecutive patients with benign or malignant disease of the large intestine aged an average of 66 years (range 54-71) were operated on. Thirty received conventional resection and 34 were operated on laparoscopically and treated perioperatively using the fast-track program. The hospital diet was given in all cases on the 1st postoperative day, and the first bowel movement occurred on the 2nd day (range 2-3). The patients could be released on the 4th postresection day (range 4-5). General and local postoperative complications were observed in five patients each (8%), including two cases of anastomotic insufficiency.


CONCLUSIONS
In colonic surgery, the "fast-track" method accelerated convalescence, lowered the number of general complications, and reduced the duration of hospital stay. Therefore, evaluation of "fast-track" concepts is warranted in other types of elective abdominal surgery.
Universitätsklinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Medizinische Fakultät der Humboldt-Universität zu Berlin. wolfgang.schwenk@charite.de
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Schwenk
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Raue
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Haase
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Junghans
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Müller
D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D001604:Berlin; D003082:Colectomy / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D003289:Convalescence; D019091:Critical Pathways / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004434:Early Ambulation / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013529:Surgical Wound Dehiscence / Q000453:epidemiology