Insights into fast-track colon surgery: a plea for a tailored program.
BACKGROUND
This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay.


METHODS
This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression.


RESULTS
Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001).


CONCLUSIONS
The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.
Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, St-Luc University Hospital, Université Catholique de Louvain (UCL), 10 Avenue Hippocrate, 1200, Brussels, Belgium.
L
L
Pellegrino
F
F
Lois
C
C
Remue
P
P
Forget
B
B
Crispin
D
D
Leonard
J
J
Jamart
A
A
Kartheuser
D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D012189:Retrospective Studies; D013997:Time Factors