title: [Multimodal (fast-track) rehabilitation in elective colorectal surgery: evaluation of the learning curve with 300 patients].
abstract: BACKGROUND
  The aim of this paper is to assess the learning curve on compliance to the application of a multimodal rehabilitation program (MMRP) protocol and patient recovery after elective colorectal surgery.
  
  
  METHODS
  A comparative prospective study of 3 consecutive cohorts of 100 patients (P1, P2 and P3) who had colonic or rectal surgery. The same MMRP protocol was applied in all cases. Compliance to the protocol, tolerance to the diet and walking have been analysed. The percentages of early hospital discharges have also been compared.
  
  
  RESULTS
  Compliance gradually improved, reaching statistical significance between P1 and P3. Starting the diet on day 1 post-surgery was 52% vs 86% (p=0.0001) and the removal of drips was 21% vs 40% (p=0.005). This difference remained during days 2 and 3. Tolerance to the diet on day 1 (P1: 34% vs. P3: 66%; p=0.0001) and walking on day 2 (P1: 41% vs. P3: 68%; p=0.0002) were also better in the third period. No differences in morbidity were found between the three periods. The percentage of hospital discharges on day 3 P1: 1% vs. P3: 15%; p=0.0003), day 4 (P1: 12% vs. P3: 32%; p=0.001) and day 5 (P1: 30% vs. P3: 50%; p=0.002) was higher in the third period.
  
  
  CONCLUSIONS
  The compliance to the protocol and the results of applying the MMRP improved significantly with the greater experience of the professionals involved.
authors.affiliation: Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario del Mar, Barcelona, España.
authors.forename: Silvia
authors.initials: S
authors.lastname: Salvans
authors.forename: María José
authors.initials: MJ
authors.lastname: Gil-Egea
authors.forename: María Angeles
authors.initials: MA
authors.lastname: Martínez-Serrano
authors.forename: Elionor
authors.initials: E
authors.lastname: Bordoy
authors.forename: Sandra
authors.initials: S
authors.lastname: Pérez
authors.forename: Marta
authors.initials: M
authors.lastname: Pascual
authors.forename: Sandra
authors.initials: S
authors.lastname: Alonso
authors.forename: David
authors.initials: D
authors.lastname: Parés
authors.forename: Ricard
authors.initials: R
authors.lastname: Courtier
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
mesh_terms: D000368:Aged; D003107:Colorectal Surgery / Q000534:rehabilitation* / Q000592:standards*; D003131:Combined Modality Therapy; D017558:Elective Surgical Procedures; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D059032:Learning Curve; D008297:Male; D011446:Prospective Studies; D013997:Time Factors