title: Fast-track rehabilitation in elective colorectal surgery patients: a prospective clinical and immunological single-centre study.
abstract: 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.
authors.affiliation: Department of Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany. matthias.wichmann@nwahs.sa.gov.au
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Wichmann
authors.forename: Ricarda
authors.initials: R
authors.lastname: Eben
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
authors.forename: Franzis
authors.initials: F
authors.lastname: Brandenburg
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
mesh_terms: 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
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein