Colonic surgery with accelerated rehabilitation or conventional care.
BACKGROUND
For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome after colonic resection with conventional care compared with fast-track multimodal rehabilitation.


METHODS
One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2) in another hospital. Outcomes were time to first defecation after surgery, postoperative hospital stay, and morbidity during the first postoperative month.


RESULTS
Median age was 74 years (group 1) and 72 years (group 2). American Society of Anesthesiologists (ASA) score was significantly higher in group 2 ( P < 0.05). Defecation occurred on day 4.5 in group 1 and day 2 in group 2 ( P < 0.05). Median hospital stay was 8 days in group 1 and 2 days in group 2 ( P < 0.05). The use of a nasogastric tube was longer in group 1 ( P < 0.05). The overall complication rate (35 patients) was lower in group 2 ( P < 0.05), especially cardiopulmonary complications (5 patients; P < 0.01). Readmission was necessary in 12 percent of cases for group 1 and 20 percent in group 2 ( P > 0.05).


CONCLUSIONS
Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast-track multimodal rehabilitation.
Department of Surgical Gastroenterology 435, Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark.
Linda
L
Basse
Jens Erik
JE
Thorbøl
Kristine
K
Løssl
Henrik
H
Kehlet
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D003082:Colectomy / Q000379:methods / Q000534:rehabilitation*; D003110:Colonic Neoplasms / Q000601:surgery*; D003672:Defecation / Q000502:physiology; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies