title: [Implementation of a perioperative multimodal rehabilitation protocol in elective colorectal surgery. A prospective randomised controlled study].
abstract: BACKGROUND
  Multimodal rehabilitation (MMR) consists of a combination of several methods for management of the surgical patient, designed to reduce the response to surgical stress and a more comfortable and earlier recovery.
  
  
  OBJECTIVE
  To assess the implementation of an MMR protocol in a Colorectal Surgery Unit, and to compare the results with the traditional model, as well as assessing its efficacy as regards recovery and hospital stay.
  
  
  METHODS
  A total of 119 patients who received elective surgery for colorectal diseases in a period during 2009-2010 were prospectively and randomly analysed. The patients were divided into 2 groups: 58 patients were assigned to the traditional group and 61 to the MMR group. The MMR group protocol consisted of, preoperative education, early feeding and mobilisation.
  
  
  RESULTS
  Both groups were homogeneous as regards the preoperative variables evaluated, the type of disease and the procedures carried out. The nasogastric tube was kept in place for 4 (1-9) days compared to 1 day (0-2) in the MMR group, with no differences in the number of re-insertions. Significant differences were found in the introduction of a liquid diet (3 [1-5] days traditional versus 0 [0-2] MMR) (P<.001), and passing of first flatulence (3 [1-6] days traditional versus 1 [1-3] MMR) (P<.001). The MMR group had a postoperative stay of 4.15±2.18 versus 9.23±6.97 days in the traditional group (P<.001). No significant differences were found in complications or readmissions.
  
  
  CONCLUSIONS
  MMR in colorectal surgery in the Spanish public health system is feasible and enables surgical patients to have a faster recovery without increasing complications, leading to an earlier hospital discharge.
authors.affiliation: Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario, Valencia, Spain. stephaniegarcia@telefonica.net
authors.forename: Stephanie
authors.initials: S
authors.lastname: García-Botello
authors.forename: Raúl
authors.initials: R
authors.lastname: Cánovas de Lucas
authors.forename: Carlos
authors.initials: C
authors.lastname: Tornero
authors.forename: Benjamín
authors.initials: B
authors.lastname: Escamilla
authors.forename: Alejandro
authors.initials: A
authors.lastname: Espí-Macías
authors.forename: Pedro
authors.initials: P
authors.lastname: Esclapez-Valero
authors.forename: Blas
authors.initials: B
authors.lastname: Flor-Lorente
authors.forename: Eduardo
authors.initials: E
authors.lastname: García-Granero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000534:rehabilitation; D017558:Elective Surgical Procedures / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies