An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery.
BACKGROUND
Enhanced perioperative care programs have been developed in order to attenuate the impact of surgical stress on organ dysfunction, thereby accelerating hospital discharge and reducing morbidity. The implementation of a fast-track program for laparoscopic colorectal surgery is reported.


METHODS
We report on a series of patients who entered a coordinated program based on preoperative patient education and counseling, a laparoscopic approach, provision of postoperative epidural analgesia, early food intake and mobilization, and structured surgical and nursing care practices. The program was introduced in September 2006 and adapted to our institutional needs. Outcome measures included length of hospital stay, return of bowel function, incidences of postoperative complications, and rate of readmission to hospital.


RESULTS
Twenty-five patients were selected by the surgeons for the accelerated laparoscopic colorectal pathway. The median duration of hospital stay was 3 (95% confidence interval, 3-4) days. Sixteen patients (64%) were discharged from hospital on day 3. Nine patients failed the pathway for various reasons (social indications, poor pain relief, wound infection, anemia, urinary retention) and were discharged later (six patients on day 4, two patients on day 5, and one patient on day 6). Times to recover bowel function and to resume a full diet were all within the first 36 hr from time of surgery. There were two readmissions.


CONCLUSIONS
This early clinical experience demonstrates the feasibility of a fast-track program for colonic surgery and the requirement for an integrated multidisciplinary approach to perioperative care.
Carli
Franco
F
Department of Anesthesia, McGill University Health Centre, 1650 Cedar Avenue, Room D10.144, Montreal, QC, H3G 1A4, Canada. franco.carli@mcgill.ca
Charlebois
Patrick
P
Baldini
Gabriele
G
Cachero
Oliver
O
Stein
Barry
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D019033:Delivery of Health Care, Integrated / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods*; D020127:Recovery of Function; D013997:Time Factors