Future perspectives and research initiatives in fast-track surgery.
OBJECTIVE
Major surgery is still followed by a risk of morbidity, a need for hospitalisation and convalescence. Fast-track surgery has been introduced as a coordinated effort to combine unimodal evidence-based principles of care into a multi-modal effort to enhance recovery. The aim of this article was to update recent data on fast-track abdominal surgery and outline future strategies for research.


RESULTS
The data from fast-track colonic resection support the validity of the concept because pain, ileus, cardiopulmonary function and muscle function were all improved, compared with traditional treatment and with reduced post-operative fatigue and convalescence. Although less data is available, similar positive results may be achieved in other types of major surgery. Current research initiatives include improved multi-modal non-opioid analgesia, rational principles for perioperative fluid management, pharmacological reduction of surgical stress responses and the role of laparoscopic procedures within the fast-track concept.


CONCLUSIONS
Fast-track surgery has evolved as a valid concept to improve post-operative outcome. Further progress may be expected based upon intensified research within perioperative pathophysiology and a multi-disciplinary collaboration between surgeons, anaesthesiologists and surgical nurses.
Kehlet
Henrik
H
Section for Surgical Pathophysiology, the Juliane Marie Centre, 4074, Rigshospitalet, 2100 Copenhagen, Denmark. henrik.kehlet@rh.dk
D000005:Abdomen / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods* / Q000639:trends; D005440:Fluid Therapy; D006801:Humans; D045823:Ileus / Q000517:prevention & control; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures / Q000639:trends*; D011183:Postoperative Complications / Q000517:prevention & control*