Fast-track surgery after laparoscopic colorectal surgery: Is it feasible in a general surgery unit?
Accepted 29 September 2009. published online 06 November 2009.
Background
The aim of the “fast-track surgery” program is to decrease the peri-operative stress response to surgical trauma and thus to a decrease in complication rates after elective surgery. Critics of fast-track (FT) rehabilitation may argue that all reports of successful programs came from major specialized hospital units and that implementation in smaller or less specialized units may be difficult if not impossible.
Methods
We retrospectively studied 101 patients who, from November 2004 to October 2007, underwent laparoscopic colorectal surgery in our institute. A detailed FT surgery protocol had been prepared and given to patients, physicians and nurses, with the aim to create a standard treatment. Data about demographics, ASA score, pre-operative complicating diseases, diagnosis, type of surgery, and postoperative clinical data were analyzed. Univariate analysis of the relationship between all factors (patient characteristics, intervention characteristics, protocol compliance and presence of complications) described here and length of hospital stay was performed.
Results
We compared our results to published major trials and observed no substantial differences in morbidity, mortality and length of postoperative hospital stay between the 2. Univariate analysis showed that compliance to the elements of the FT protocol influences the length of postoperative period more significantly than patient characteristics or surgical procedure.
Conclusion
Based on 6 comparative single-center studies, the FT program was found to reduce length of hospital stay, and was deemed safe for major abdominal surgeries. Present study shows that enhanced recovery or FT program can also be implemented safely in a general surgery unit.
aGeneral Surgery Unit, Misericordia e Dolce Hospital, Prato, Italy
bDepartment of Public Health, University of Florence, Florence, Italy
cGeneral Surgery Unit, San Donato Hospital, Arezzo, Italy
Reprint requests: Francesco Feroci, MD, General Surgery Unit, Misericordia e Dolce Hospital, Piazza dell'Ospedale 5, 59100 Prato, Italy.
ABSTRACT