title: A fast-track recovery protocol improves outcomes in elective laparoscopic colectomy for diverticulitis.
abstract: BACKGROUND
  Fast-track (FT) postoperative protocols have been shown to be highly beneficial in open colectomy. Some have questioned the necessity of an FT protocol in the setting of laparoscopic colectomy because hospital stays are short and morbidity is low compared with open surgery. We set out to determine whether an FT protocol has any utility in the setting of elective laparoscopic colectomy.
  
  
  METHODS
  A retrospective review was conducted on a cohort of 334 patients who underwent elective laparoscopic sigmoid resection for diverticulitis from 1998 to 2008, at Mayo Clinic, a tertiary care center in Rochester, MN. There were 235 patients who were managed with traditional postoperative care, and 99 who were managed with an FT protocol initiated in 2006. The main outcomes measures were time to soft diet, length of stay, overall morbidity, and readmission rate.
  
  
  RESULTS
  Times to soft diet (mean 2.3 vs 3.6 days), and first bowel movement (mean 2.6 vs 3.5 days) were shorter in the FT group (p < 0.001). The median lengths of stay were 3 days (interquartile range 3 to 4 days) and 5 days (interquartile range 4 to 6 days) for the FT and non-FT groups, respectively (p < 0.001). Morbidity was significantly lower in the FT group compared with the non-FT group (15.2% vs 25.5%, p < 0.03). The 30-day readmission rate was 2.9% for the FT group and 7.6% for the non-FT group (p = NS). There were no deaths in either group.
  
  
  CONCLUSIONS
  Even in patients undergoing laparoscopic colectomy, FT protocols further improve the speed of gastrointestinal recovery, shorten the length of stay, and decrease morbidity.
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA. larson.david2@mayo.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Niles J
authors.initials: NJ
authors.lastname: Batdorf
authors.forename: John G
authors.initials: JG
authors.lastname: Touzios
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.forename: Heidi K
authors.initials: HK
authors.lastname: Chua
authors.forename: John H
authors.initials: JH
authors.lastname: Pemberton
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
mesh_terms: D002985:Clinical Protocols; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery; D003289:Convalescence; D004239:Diverticulitis, Colonic / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome