Convalescence after colonic surgery with fast-track vs conventional care.
OBJECTIVE
To compare convalescence after colonic surgery with a fast-track rehabilitation programme vs conventional care.


BACKGROUND
Introduction of a multimodal rehabilitation programme (fast-track) with focus on epidural anaesthesia, minimal invasive surgical techniques, optimal pain control, and early nutrition and mobilization together with detailed patient information have led to a shorter hospital stay after colonic surgery. There are not much data on convalescence after discharge.


METHODS
A prospective, controlled, non-randomized interview-based assessment in 160 patients undergoing an elective, uncomplicated, open colonic resection or the Hartmann reversal procedure with a fast-track or a conventional care programme in two university hospitals. A structured interview-based assessment was performed preoperatively, and day 14 and 30 postoperatively.


RESULTS
Patients undergoing colonic surgery with a fast-track programme regained functional capabilities earlier with less fatigue and need for sleep compared with patients having conventional care. Despite early discharge of the fast-track patients (mean 3.4 days vs 7.5 days), no differences were found according to the need for home care, social care and visit to general practitioners, although the fast-track group had an increased number of visits at the outpatient clinic for wound care. More patients in the fast-track group were re-admitted, but the overall mean total hospital stay was 4.2 days vs 8.3 days in the conventional group.


CONCLUSIONS
A fast-track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection.
Jakobsen
D H
DH
Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark. dorthe.hjort@rh.dk
Sonne
E
E
Andreasen
J
J
Kehlet
H
H
D000368:Aged; D000714:Anastomosis, Surgical / Q000534:rehabilitation; D003107:Colorectal Surgery / Q000534:rehabilitation*; D003289:Convalescence; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome