Changes in outcome during implementation of a fast-track colonic surgery project in a university-affiliated general teaching hospital: advantages reached with ERAS (Enhanced Recovery After Surgery project) over a 1-year period.
OBJECTIVE
The aim of this study was to investigate whether changes can be accomplished rapidly after implementing a fast-track colonic surgery project at a university-affiliated general teaching hospital.


METHODS
In 2004 and 2005 all colonic surgery patients were recorded for a number of pre-, per- and postoperative care elements. In 2006, during the implementation of a fast-track program, changes were recorded.


RESULTS
Before the implementation of the fast-track regime at our hospital, 97% of the patients (n = 89/92) received mechanical bowel preparation, in contrast to 3% (n = 1/36) afterwards (p < 0.0001). The application of thoracic epidural analgesia rose from 46% (n = 42/92) in 2004 and 2005 to 94% (n = 34/36) in 2006 (p < 0.0001). The use of nasogastric tubes postoperatively almost disappeared. 77% (n = 28/36) enjoyed a small meal on the 1st day after operation, compared to 0% (n = 0/92) in 2004 and 2005 (p < 0.0001). Median hospital stay was 6 (range 3-27) nights in 2006 compared to 9 (range 3-25) nights in 2005 and 9.5 (range 7-64) nights in 2004 (p < 0.005).


CONCLUSIONS
These preliminary results show that also at a district general teaching hospital advantages can be reached rapidly and safely by implementing fast-track surgery; especially a faster recovery.
Jottard
K J C
KJ
Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. K.Jottard@surgery.azm.nl
van Berlo
C
C
Jeuken
L
L
Dejong
C
C
D015360:Analgesia, Epidural / Q000379:methods; D003082:Colectomy / Q000379:methods / Q000534:rehabilitation*; D003108:Colonic Diseases / Q000534:rehabilitation* / Q000601:surgery*; D003110:Colonic Neoplasms / Q000534:rehabilitation / Q000601:surgery; D019091:Critical Pathways; D004435:Eating; D017558:Elective Surgical Procedures / Q000534:rehabilitation; D004733:Enema / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019990:Perioperative Care / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome