[Accelerated postoperative recovery after colorectal surgery].
Accelerated recovery programs are clinical pathways which outline the stages, and streamline the means, and techniques aiming toward the desired end a rapid return of the patient to his pre-operative physical and psychological status. Recovery from colo-rectal surgery may be slowed by the patient's general health, surgical stress, post-surgical pain, and post-operative ileus. Both surgeons and anesthesiologists participate throughout the peri-operative period in a clinical pathway aimed at minimizing these delaying factors. Key elements of this pathway include avoidance of pre-operative colonic cleansing, early enteral feeding, and effective post-operative pain management permitting early ambulation (usually via thoracic epidural anesthesia). Pre-operative information and motivation of the patient is also a key to the success of this accelerated recovery program. Studies of such programs have shown decreased duration of post-operative ileus and hospital stay without an increase in complications or re-admissions. The elements of the clinical pathway must be regularly re-evaluated and updated according to local experience and published data.
Alfonsi
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P
Département d'Anesthésie-Réanimation, Hôpital A. Paré, Boulogne Cedex. pascal.alfonsi@apr.aphp.fr
Schaack
E
E
D003106:Colon / Q000601:surgery*; D004434:Early Ambulation; D006801:Humans; D018579:Patient Selection; D011182:Postoperative Care; D011300:Preoperative Care; D020127:Recovery of Function; D012007:Rectum / Q000601:surgery*