title: Enhanced recovery after elective colorectal resection outside a strict fast-track protocol. A single centre experience.
abstract: BACKGROUND
  Optimising the management of hospitalised patients is a major concern. In colorectal surgery, the concept of enhanced recovery has been popularised by means of "fast-track" protocols, aiming at patient's discharge on the second postoperative day. Nevertheless, a strict fast-track protocol has several limitations. It is very demanding for the patient and therefore applicable only to a limited number of patients.
  
  
  OBJECTIVE
  In order to optimise, in every aspect, the postoperative recovery of each patient undergoing an elective colorectal resection inside our institution, we set up a "soft" enhanced recovery programme.
  
  
  METHODS
  A retrospective analysis was conducted in 92 patients evaluating the respective impact of protocol application throughout the duration of the hospital stay.
  
  
  RESULTS
  When all the required measures of our protocol were correctly implemented, the median discharge day was postoperative day 3 (range 3-5 days). On the contrary, when deviations occurred, they resulted in longer hospital stay (p < 0.001). Patients operated by laparoscopy were discharged earlier than patients operated by laparotomy (p < 0.001). The use of nasogastric tube and postoperative drainage prolonged significantly the length of stay (p = 0.001 and p < 0.001 respectively). When the urinary catheter was not removed or oral feeding not resumed on postoperative day 1, the patients were discharged later (p < 0.001).
  
  
  CONCLUSIONS
  There are substantial possibilities of optimising the recovery process after an elective colorectal resection, outside a strict fast-track protocol.
authors: Clinic of Colorectal Surgery, Department of Digestive Surgery, Erasme University Hospital-Université Libre de Bruxelles, Brussels, Belgium, apostolos.agrafiotis@gmail.com.
authors: A C
authors: AC
authors: Agrafiotis
authors: M
authors: M
authors: Corbeau
authors: A
authors: A
authors: Buggenhout
authors: G
authors: G
authors: Katsanos
authors: B
authors: B
authors: Ickx
authors: J
authors: J
authors: Van de Stadt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge; D016896:Treatment Outcome
references: BMC Cancer. 2011 Nov 24;11:494
references: 22111914
references: World J Gastrointest Surg. 2011 Jan 27;3(1):1-6
references: 21286218
references: BMJ. 2001 Feb 24;322(7284):473-6
references: 11222424
references: J Laparoendosc Surg. 1991 Aug;1(4):217-20
references: 1834272
references: Surg Laparosc Endosc. 1991 Sep;1(3):144-50
references: 1688289
references: Int J Colorectal Dis. 2009 Oct;24(10):1119-31
references: 19415308
references: Clin Colon Rectal Surg. 2009 Feb;22(1):60-72
references: 20119558
references: Ann Surg. 2011 Dec;254(6):868-75
references: 21597360
references: Int J Colorectal Dis. 2013 Jan;28(1):103-9
references: 22941115
references: Acta Chir Belg. 2005 Nov-Dec;105(6):555-9
references: 16438063
references: Br J Surg. 2006 Jul;93(7):800-9
references: 16775831
references: Br J Surg. 1999 Feb;86(2):227-30
references: 10100792