[Establishing "fast-track"-colonic surgery in the clinical routine].
OBJECTIVE
A multimodal perioperative concept ("fast-track"-surgery) may decrease the incidence of general complications following elective colonic resections, accelerate rehabilitation and shorten postoperative hospital stay. During the introduction of this new "clinical pathway" several obstacles have to be overcome. This manuscript describes a practical way to establish "fast-track"-colonic surgery in the clinical routine.


METHODS
After discussion of the many aspects of perioperative pathophysiology following abdominal surgery a "fast-track"-concept for colonic surgery was defined. Since 11.10.2001 the "fast-track" concept was applied to all patients treated by one attending surgeon. Experience with establishing this concept in the clinical routine was analysed.


RESULTS
"Fast-track"-colonic surgery was established in close cooperation between surgeons, anesthesiologists and nurses. A written-down concept, the use of checklists and letters of information for patients, their relatives and general practicioners will simplify the introduction of the new perioperative treatment. Traditional practice (i. e. types of incisions, use of drainage, postoperative oral feeding) have to be modified. In 74 "fast-track"-colonic resections postoperative hospital stay was reduced to a median of 4 days, regardless of the way of access to the abominal cavity (laparoscopic or conventional). Postoperative morbidity was acceptable (local complications: 7 %; general complications: 7 %, but only 1 % without local complication).


CONCLUSIONS
Establishing "fast-track"-colonic surgery requires close cooperation between surgery, anestehsiology and nursing personal. Most important is a surgeon prepared to overcome traditional concepts of perioperative care.
Schwenk
W
W
Universitätsklinik für Allgemein-, Viszeral-, Gefäss- und Thoraxchirurgie, Universitäre Medizin Berlin, Charité, Campus Mitte, Medizinische Fakultät der Humboldt-Universität zu Berlin. wolfgang.schwenk@charite.de
Haase
O
O
Raue
W
W
Neudecker
J
J
Müller
J M
JM
D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D003289:Convalescence; D003627:Data Interpretation, Statistical; D006801:Humans; D007902:Length of Stay; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D013997:Time Factors