"Fast-track" rehabilitation for elective colonic surgery in Germany--prospective observational data from a multi-centre quality assurance programme.
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.
Schwenk
W
W
General-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. wolfgang.schwenk@charite.de
Günther
N
N
Wendling
P
P
Schmid
M
M
Probst
W
W
Kipfmüller
K
K
Rumstadt
B
B
Walz
M K
MK
Engemann
R
R
Junghans
T
T
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
Int J Colorectal Dis. 2001 Nov;16(6):362-9
11760897
Zentralbl Chir. 2003 Dec;128(12):1086-92
14750071
Dis Colon Rectum. 2004 Nov;47(11):1883-8
15622581
Dis Colon Rectum. 2004 Mar;47(3):271-7; discussion 277-8
14991487
Clin Nutr. 2005 Jun;24(3):466-77
15896435
World J Surg. 2004 Jan;28(1):92-6
14639493
N Engl J Med. 2006 Dec 21;355(25):2640-51
17182989
Am J Surg. 2005 Mar;189(3):268-72
15792748
Br J Surg. 2003 Dec;90(12):1497-504
14648727
World J Surg. 2005 Aug;29(8):1013-21; discussion 1021-2
15981044
Chirurg. 2004 May;75(5):508-14
15007524
Chest. 2006 Jan;129(1):174-81
16424429
J Am Coll Surg. 2006 Jan;202(1):45-54
16377496
Surgery. 2003 Mar;133(3):277-82
12660639
Br J Surg. 2006 Jul;93(7):800-9
16775831
Br J Surg. 1999 Feb;86(2):227-30
10100792
Lancet. 1995 Mar 25;345(8952):763-4
7891489
Surg Endosc. 2001 Feb;15(2):116-20
11285950
Ann Surg. 2000 Jul;232(1):51-7
10862195