title: Which fast track elements predict early recovery after colon cancer surgery?
abstract: OBJECTIVE
  It is questioned whether all separate fast track elements are essential for enhanced postoperative recovery. We aimed to determine which baseline characteristics and which fast track elements are independent predictors of faster postoperative recovery in patients undergoing resection for colon cancer.
  
  
  METHODS
  Data from the LAFA trial database were used. In this trial, fast track care was compared with standard perioperative care in 400 patients undergoing laparoscopic or open surgery for colonic cancer. During admission 19 fast track elements per patient were prospectively evaluated and scored whether or not they were successfully applied. To identify predictive factors six baseline characteristics and those fast track items that were successfully achieved were entered in a univariate and multivariate linear regression analysis with total postoperative hospital stay (THS) as the primary outcome.
  
  
  RESULTS
  In 400 patients, two baseline characteristics and two fast track elements were found to be significant independent predictors of THS: female sex [B = 0.85; 95% CI 0.75-0.96; reduction of 15% (CI 14-25%) in THS], laparoscopic resection [B = 0.85; 95% CI 0.75-0.96; reduction of 15% (CI 14-25%) in THS], 'normal diet at postoperative days 1, 2 and 3' [B = 0.70; 95% CI 0.61-0.81; reduction of 30% (CI 19-39%) in THS] and 'enforced mobilization at postoperative days 1, 2 and 3' [B = 0.68; 95% CI 0.59-0.80; reduction of 32% (CI 20-41%) in THS].
  
  
  CONCLUSIONS
  Evaluating only those fast track elements that were successfully achieved, enforced advancement of oral intake, early mobilization, laparoscopic surgery and female sex were independent determinants of early recovery.
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. w.a.bemelman@amc.uva.nl
authors: M S
authors: MS
authors: Vlug
authors: S A L
authors: SA
authors: Bartels
authors: J
authors: J
authors: Wind
authors: D T
authors: DT
authors: Ubbink
authors: M W
authors: MW
authors: Hollmann
authors: W A
authors: WA
authors: Bemelman
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies; D020127:Recovery of Function; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome