Fast-track management is safe and effective after bowel resection in children with Crohn's disease.
BACKGROUND
"Fast-track" management (FT) challenges traditional postoperative tenets in order to minimize discomfort and optimize inpatient care. We examined the outcomes of consecutively performed laparoscopic-assisted ileocecectomy for Crohn's disease (CD), with particular focus on FT's effects in patients with underlying bowel inflammation.


METHODS
We retrospectively reviewed all patients undergoing isolated laparoscopic-assisted ileocecectomy for CD at our institution between 12/2000 and 12/2010, excluding patients with multiple areas of surgical CD, bladder involvement, or age >18years.


RESULTS
Seventy-one patients aged 8-18years underwent isolated laparoscopic-assisted ileocecectomy for CD, of which 45 met FT criteria. Individual practice patterns primarily determined which patients were FT-managed. FT management led to decreased length of stay (LOS), time to first stool, time to full diet, and intravenous narcotic use. No significant difference in complications or disease progression was observed between the two groups during 2-year follow up.


CONCLUSIONS
Our results suggest that FT is safe and effective in patients with CD. In a chronically ill population, counseling patients and families to expect early discharge is critical to the success of this strategy. Despite CD-related GI pathology, FT patients realized benefits in terms of LOS, time to bowel function, and narcotic use without any increase in complications.
The Children's Hospital of Philadelphia, Philadelphia, PA.
Jesse D
JD
Vrecenak
The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: mattei@email.chop.edu.
Peter
P
Mattei
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D003424:Crohn Disease / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007080:Ileocecal Valve / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D013488:Suppositories; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D013488:Suppositories
Crohn's disease; Fast track; Laparoscopic; Postoperative management