title: A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery.
abstract: 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.
authors.affiliation: Centre for Surgical Sciences, Division of Surgery, Karolinska Institutet and Centre of Gastrointestinal Disease, Ersta Hospital, PO Box 4622, 11691 Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nygren
authors.forename: Jonatan
authors.initials: J
authors.lastname: Hausel
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.forename: Arthur
authors.initials: A
authors.lastname: Revhaug
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Lassen
authors.forename: Cornelius
authors.initials: C
authors.lastname: Dejong
authors.forename: Jens
authors.initials: J
authors.lastname: Andersen
authors.forename: Maarten
authors.initials: M
authors.lastname: von Meyenfeldt
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
authors.forename: Kenneth Christopher
authors.initials: KC
authors.lastname: Fearon
mesh_terms: 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