title: "Fast-track" rehabilitation for elective colonic surgery in Germany--prospective observational data from a multi-centre quality assurance programme.
abstract: BACKGROUND
  The results of "Fast-track" colonic surgery in an unselected population outside of specialised units has been unknown yet.
  
  
  METHODS
  Data from 24 German hospitals performing "Fast-track" rehabilitation as the standard peri-operative care for patients undergoing elective colonic resection were collected in a prospective multi-centre study conducted between April 2005 and September 2006 to evaluate local and general morbidity.
  
  
  RESULTS
  One thousand and forty-seven patients undergoing elective "fast-track" colonic resection were included. Compliance to essential parts of "fast-track" rehabilitation was high (epidural analgesia 86,6%, early oral feeding and mobilisation on the day of surgery 85.5 and 85.4%). Surgical morbidity was observed in 148 patients (14.1%) and general morbidity in 95 patients (9.1%), while mortality was 0.8%. Predefined discharge criteria were met within 5 (1-83) days after surgery, but because of economical restraints in the German DRG system, patients were discharged only after 8 (3-83) days. Re-admission rate was 3.9%.
  
  
  CONCLUSIONS
  "Fast-track" rehabilitation for elective colonic resection was safe and feasible in German hospitals of all sizes and yielded a low general morbidity and re-admission rate. Post-operative recovery was enhanced, but discharge from hospital was delayed because of economical reasons.
authors: General-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. wolfgang.schwenk@charite.de
authors: W
authors: W
authors: Schwenk
authors: N
authors: N
authors: Günther
authors: P
authors: P
authors: Wendling
authors: M
authors: M
authors: Schmid
authors: W
authors: W
authors: Probst
authors: K
authors: K
authors: Kipfmüller
authors: B
authors: B
authors: Rumstadt
authors: M K
authors: MK
authors: Walz
authors: R
authors: R
authors: Engemann
authors: T
authors: T
authors: Junghans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects; D003082:Colectomy / Q000009:adverse effects / Q000534:rehabilitation*; D004434:Early Ambulation / Q000009:adverse effects; D004435:Eating; D017558:Elective Surgical Procedures / Q000534:rehabilitation; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006302:Health Services Research; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D015397:Program Evaluation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
references: Int J Colorectal Dis. 2001 Nov;16(6):362-9
references: 11760897
references: Zentralbl Chir. 2003 Dec;128(12):1086-92
references: 14750071
references: Dis Colon Rectum. 2004 Nov;47(11):1883-8
references: 15622581
references: Dis Colon Rectum. 2004 Mar;47(3):271-7; discussion 277-8
references: 14991487
references: Clin Nutr. 2005 Jun;24(3):466-77
references: 15896435
references: World J Surg. 2004 Jan;28(1):92-6
references: 14639493
references: N Engl J Med. 2006 Dec 21;355(25):2640-51
references: 17182989
references: Am J Surg. 2005 Mar;189(3):268-72
references: 15792748
references: Br J Surg. 2003 Dec;90(12):1497-504
references: 14648727
references: World J Surg. 2005 Aug;29(8):1013-21; discussion 1021-2
references: 15981044
references: Chirurg. 2004 May;75(5):508-14
references: 15007524
references: Chest. 2006 Jan;129(1):174-81
references: 16424429
references: J Am Coll Surg. 2006 Jan;202(1):45-54
references: 16377496
references: Surgery. 2003 Mar;133(3):277-82
references: 12660639
references: Br J Surg. 2006 Jul;93(7):800-9
references: 16775831
references: Br J Surg. 1999 Feb;86(2):227-30
references: 10100792
references: Lancet. 1995 Mar 25;345(8952):763-4
references: 7891489
references: Surg Endosc. 2001 Feb;15(2):116-20
references: 11285950
references: Ann Surg. 2000 Jul;232(1):51-7
references: 10862195