A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery.
OBJECTIVE
This study reviewed the case mix, clinical management, and clinical outcomes of patients undergoing colorectal resection in five European centres performing different forms of conventional or 'fast-track' perioperative care.


METHODS
The perioperative care programme and surgical practice in each centre was defined. Patient data were collected by case-note review on an internet-based audit system. Case mix was determined using ASA classification and the P-POSSUM scoring system.


RESULTS
A total of 451 consecutive patients from units practicing either conventional (Sweden, n=109; UK, n=87; Netherlands, n=76, Norway, n=61) or fast-track surgery (Denmark, n=118), were studied between 1998 and 2001. Elements of perioperative practice varied widely both between units practicing 'traditional' care and the reference 'fast-track' unit (Denmark). Based on the P-POSSUM scores, the case mix was similar between centres. There were no differences in morbidity or 30-day mortality between the different centres. The median length of stay was 2 days in Denmark and 7-9 days in the other centres (P<0.05). The readmission rate was 22% in Denmark and 2-16% in the other centres (P<0.05).


CONCLUSIONS
Compared with traditional care, fast-track perioperative care results in a reduced length of hospital stay but may be associated with a higher readmission rate. Morbidity and mortality appears to be similar with either approach. Prospective evaluation of the potential benefits of the fast-track approach in different European centres is merited.
Nygren
Jonas
J
Centre for Surgical Sciences, Division of Surgery, Karolinska Institutet and Centre of Gastrointestinal Disease, Ersta Hospital, PO Box 4622, 11691 Stockholm, Sweden.
Hausel
Jonatan
J
Kehlet
Henrik
H
Revhaug
Arthur
A
Lassen
Kristoffer
K
Dejong
Cornelius
C
Andersen
Jens
J
von Meyenfeldt
Maarten
M
Ljungqvist
Olle
O
Fearon
Kenneth Christopher
KC
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D010359:Patient Readmission; D019990:Perioperative Care / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment