Abstract
Multi-modal rehabilitation with an emphasis on preoperative information, reduction of surgical stress responses, optimized dynamic pain relief with continuous epidural analgesia and early mobilization and oral nutrition may reduce hospital stay, morbidity, convalescence, and costs (fast-track surgery). Current results from fast-track colonic surgery suggest that postoperative pulmonary, cardiovascular, and muscle function are improved and body composition preserved as well as a normal oral intake of energy and protein can be achieved. Consequently, hospital stay is reduced to about 2–4 days, with decreased fatigue and need for sleep in the convalescence period. Despite a higher risk for readmissions, overall costs and morbidity seem to be reduced. Existing data from several institutions support the concept of fast-track colonic surgery to improve postoperative organ functions, thereby allowing for early rehabilitation with decreased hospital stay, convalescence, and costs. Further data are needed frommulti-national institutions on morbidity, safety, and costs.
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References
Kehlet H, Dahl JB (2003) Anaesthesia, surgery and challenges for postoperative recovery. Lancet 362:1921–1928
Kehlet H, Wilmore DW (2002) Multi-modal strategies to improve surgical outcome. Am J Surg 183:630–641
Basse L, Jakobsen DH, Billesbølle P, Werner M, Kehlet H(2000) Aclinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57
Wexner S (1998) Standard perioperative care protocols and reduced length of stay after colon surgery. Am J Coll Surg 186:589–593
Holte K, Kehlet H (2002) Epidural anaesthesia and analgesia-effects on surgical stress responses and implications for postoperative nutrition. Clin Nutr 21:199–206
Jørgensen H, Wetterslev J, Mønniche S, Dahl JB (2001) Epidural local anaesthetics vs opioid based analgesic regiments on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery (Cochrane review). Cochrane Library, issue 2,. Oxford: Update Software
Basse L, Raskov H, Jakobsen DH, Sonne E, Billesbølle E, Hendel HW, Rosenberg J, Kehlet H (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition. Br J Surg:89:446–453
Carli F, Mayo N, Clubien K, Schricker T, Trudel J, Bellivau P (2002) Epidural analgesia enhances exercise capacity and health related quality of life after colonic surgery: results of a randomized trial. Anesthesiology 97:540–549
Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I (2002) Enforcedmobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Nutrition1 8:147–152
Anderson, ADG, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ (2003) Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 90:1497–1504
Henriksen MG, Hansen HV, Hessov I (2002) Early oral nutrition after elective colorectal surgery: influence of balanced analgesia and enforced mobilization. Nutrition 18:266–269
Basse L, Thorbøl JE, Løssl K, Kehlet H (2004) Convalescence after fast-track versus conventional care of colonic surgery. Dis Colon Rectum 47:271–278
Hjort Jakobsen D, Sonne E, Basse L, Bisgaard T, Kehlet H (2004) Convalescence after colonic resection with fast-track vs. conventional care. Scand J Surg (in press)
Stephen AE, Berger DL (2003) Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical pathway after elective colonic resection. Surgery 133:277–282
Delaney CP, Zutshi M, Senagore AJ, Remzi FH, Hammel J, Fazio VW (2003) Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 46:851–859
Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy. A 30-month experience. Dis Colon Rectum 46:503–509
Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patients after laparoscopic resection. Br J Surg 87:45–45
Basse L, Jacobsen DH. Billesbølle P, Kehlet H (2002) Colostomy closure after Hartman's procedure with fast-track rehabilitation. Dis Colon Rectum 45:1661–1664
DiFronzo, Yamin N, Patel K, O'Connell TX (2003) Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection. J Am Coll Surg 197:747–753
Delaney CP, Fazio VW, Senagore AJ, Robinsson B, Halvorson AL, Remzi FH (2001) Fasttrack postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538
Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease. Similarities and differences. Dis Colon Rectum 45:485–490
Holte K, Sharrock NE, Kehlet H (2002) Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 89:622–632
Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L and the Danish study group on perioperative fluid therapy (2003) Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens. Ann Surg 238:641–648
Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic and/or open colorectal surgery. Ann Surg 238:67–72
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Kehlet, H. (2005). Fast-Track Colonic Surgery: Status and Perspectives. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_2
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DOI: https://doi.org/10.1007/3-540-27449-9_2
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