Fast-track surgery may reduce complications following major colonic surgery.
OBJECTIVE
Fast-track (enhanced recovery) care pathways for colonic surgery are becoming increasingly popular; however, there have been concerns regarding protocol compliance, high readmission rates, and also the true impact on morbidity rates with these protocols. This study was conducted to assess the impact of a fast-track program for colonic surgery on hospital stay, complications, and readmission rates.


METHODS
From December 2005 to March 2007, consecutive patients undergoing colonic surgery were prospectively studied. The comparison group consisted of a comorbidity-matched group of patients who had undergone similar surgery before establishment of the fast-track program.


RESULTS
Fifty patients were included in each group. Groups were comparable at baseline. The fast-track group received significantly smaller amounts of intraoperative and postoperative intravenous fluids, were fed earlier, mobilized earlier, passed flatus earlier, and were discharged earlier than the comparison group (4 vs. 6.5 days, P < 0.001). The numbers of patients with urinary infections (2 vs. 12, P = 0.008), ileus (5 vs. 18, P = 0.005), and cardiopulmonary complications (11 vs. 21, P = 0.032) were significantly lower in the fast-track group. There was no difference in the rate of readmission.


CONCLUSIONS
Fast-track is a safe and effective approach for reducing hospital stay and morbidity following major colonic surgery.
South Auckland Clinical School, University of Auckland, Middlemore Hospital, Auckland, New Zealand.
Kamran
K
Zargar-Shoshtari
Andrew B
AB
Connolly
Lincoln H
LH
Israel
Andrew G
AG
Hill
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D015331:Cohort Studies; D003082:Colectomy / Q000451:nursing; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000451:nursing; D011183:Postoperative Complications; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome