Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study.
BACKGROUND
Recent clinical data indicate that fast-track surgery (multimodal rehabilitation) leads to shorter postoperative length of hospital stay, faster recovery of gastrointestinal function as well as reduced morbidity and mortality rates. To date, no study has focused on the effects of fast-track surgery on postoperative immune function. This study was initiated to determine whether fast-track rehabilitation results in improved clinical and immunological outcome of patients undergoing colorectal surgery.


METHODS
Forty patients underwent either conventional or fast-track rehabilitation after colorectal surgery. In addition to clinical parameters (return of gastrointestinal function, food intake, pain score, complication rates and postoperative length of stay), we determined parameters of perioperative immunity by flow cytometry (lymphocyte subgroups) and enzyme-linked immunosorbent assay (interleukin-6).


RESULTS
Our findings indicate a better-preserved cell-mediated immune function (T cells, T-helper cells, natural killer cells) after fast-track rehabilitation, whereas the pro-inflammatory response (C-reactive protein, interleukin-6) was unchanged in both study groups. Furthermore, we detected a significantly faster return of gastrointestinal function (first bowel movement P<0.001, food intake P<0.05), significantly reduced pain scores in the postoperative course (P < 0.05) and a significantly shorter length of postoperative stay (P<0.001) in patients undergoing fast-track rehabilitation.


CONCLUSIONS
Fast-track rehabilitation after colorectal surgery results in better-preserved cell-mediated immunity when compared with conventional postoperative care. Furthermore, patients undergoing fast-track rehabilitation suffer from less pain and have a faster return of gastrointestinal function in the postoperative course. In addition, postoperative length of hospital stay was significantly shorter in fast-track patients.
Wichmann
Matthias W
MW
Department of Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany. matthias.wichmann@nwahs.sa.gov.au
Eben
Ricarda
R
Angele
Martin K
MK
Brandenburg
Franzis
F
Goetz
Alwin E
AE
Jauch
Karl-Walter
KW
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D003108:Colonic Diseases / Q000534:rehabilitation* / Q000601:surgery*; D003107:Colorectal Surgery; D003672:Defecation; D004239:Diverticulitis, Colonic / Q000534:rehabilitation / Q000601:surgery; D004435:Eating; D017558:Elective Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care / Q000379:methods / Q000458:organization & administration*; D011184:Postoperative Period; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000534:rehabilitation / Q000601:surgery; D012811:Sigmoid Neoplasms / Q000534:rehabilitation / Q000601:surgery; D013997:Time Factors
D015850:Interleukin-6; D002097:C-Reactive Protein