A fast-track program reduces complications and length of hospital stay after open colonic surgery.

Details

Serval ID
serval:BIB_4B56A9D7B4C7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
A fast-track program reduces complications and length of hospital stay after open colonic surgery.
Journal
Gastroenterology
Author(s)
Muller S., Zalunardo M.P., Hubner M., Clavien P.A., Demartines N.
Working group(s)
Zurich Fast Track Study Group
Contributor(s)
Decurtins M., Eisner L., Castelli I., Keller HP., Langer I., Gelpke H., Grieder F., Carstensen T., Gehrz A., Spahr T., Paganoni R.
ISSN
1528-0012 (Electronic)
ISSN-L
0016-5085
Publication state
Published
Issued date
2009
Volume
136
Number
3
Pages
842-847
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial
Publication Status: ppublish
Abstract
BACKGROUND & AIMS: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery.
METHODS: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care. The primary end point was the 30-day complication rate. Secondary end points were severity of complications, hospital stay, and compliance with the fast-track protocol.
RESULTS: The fast-track protocol significantly decreased the number of complications (16 of 76 in the fast-track group vs 37 of 75 in the standard care group; P = .0014), resulting in shorter hospital stays (median, 5 days; range, 2-30 vs 9 days, respectively; range, 6-30; P < .0001). There was a trend toward less severe complications in the fast-track group. A multiple logistic regression analysis revealed fluid administration greater than the restriction limits (odds ratio, 4.198; 95% confidence interval, 1.7-10.366; P = .002) and a nonfunctioning epidural analgesia (odds ratio, 3.365; 95% confidence interval, 1.367-8.283; P = .008) as independent predictors of postoperative complications.
CONCLUSIONS: The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as standard care. Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program.
Keywords
Adult, Aged, Aged, 80 and over, Analgesia, Epidural, Colonic Diseases/surgery, Eating, Female, Fluid Therapy, Follow-Up Studies, Humans, Length of Stay, Logistic Models, Male, Middle Aged, Motor Activity, Patient Care Team, Postoperative Care/methods, Postoperative Complications/prevention & control, Predictive Value of Tests, Treatment Outcome
Pubmed
Web of science
Create date
02/10/2009 18:04
Last modification date
20/08/2019 13:59
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