Fast-track vs standard care in colorectal surgery: a meta-analysis update.
BACKGROUND
Fast-track (FT) protocols accelerate patient's recovery and shorten hospital stay as a result of the optimization of the perioperative care they offer. The aim of this review is to examine the latest evidence for fast-track protocols when compared with standard care in elective colorectal surgery involving segmental colonic and/or rectal resection.


METHODS
All randomized controlled trials and controlled clinical trials on FT colorectal surgery were reviewed systematically. The main end points were short-term morbidity, length of primary postoperative hospital stay, length of total postoperative stay, readmission rate, and mortality. Quality assessment and data extraction were performed independently by two observers.


RESULTS
Eleven studies were eligible for analysis (four randomized controlled trials (RCTs) and seven controlled clinical trials (CCT)), including 1,021 patients. Primary hospital stay (weighted mean difference -2.35 days, 95% confidence interval (CI) -3.24 to -1.46 days, P < 0.00001) and total hospital stay (weighted mean difference -2.46 days, 95% CI -3.43 to -1.48 days, P < 0.00001) were significantly lower for FT programs. Morbidity was also lower in the FT group. Readmission rates were not significantly different. No increase in mortality was found.


CONCLUSIONS
FT protocols show high-level evidence on reducing primary and total hospital stay without compromising patients' safety offering lower morbidity and the same readmission rates. Enhanced recovery programs should become a mainstay of elective colorectal surgery.
Department of Biosurgery and Surgical Technology, Imperial College, St. Mary's Hospital, 10th Floor, QEQM, Praed Street, London, W2 1NY, UK.
Nikolaos
N
Gouvas
Emile
E
Tan
Alistair
A
Windsor
Evaghelos
E
Xynos
Paris P
PP
Tekkis
D003107:Colorectal Surgery / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D018849:Controlled Clinical Trials as Topic; D003695:Delivery of Health Care / Q000379:methods*; D005221:Fatigue; D006801:Humans; D007107:Immune System; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D009017:Morbidity; D010147:Pain Measurement; D010359:Patient Readmission; D011788:Quality of Life; D012129:Respiratory Function Tests; D016896:Treatment Outcome