Purpose:
Fast-track (enhanced recovery) care pathways for colonic surgery are becoming increasingly popular; however, there have been concerns regarding protocol compliance, high readmission rates, and also the true impact on morbidity rates with these protocols. This study was conducted to assess the impact of a fast-track program for colonic surgery on hospital stay, complications, and readmission rates.
Methods:
From December 2005 to March 2007, consecutive patients undergoing colonic surgery were prospectively studied. The comparison group consisted of a comorbidity-matched group of patients who had undergone similar surgery before establishment of the fast-track program.
Results:
Fifty patients were included in each group. Groups were comparable at baseline. The fast-track group received significantly smaller amounts of intraoperative and postoperative intravenous fluids, were fed earlier, mobilized earlier, passed flatus earlier, and were discharged earlier than the comparison group (4vs.6.5 days,P< 0.001). The numbers of patients with urinary infections (2vs.12,P= 0.008), ileus (5vs.18,P= 0.005), and cardiopulmonary complications (11vs.21,P= 0.032) were significantly lower in the fast-track group. There was no difference in the rate of readmission.
Conclusion:
Fast-track is a safe and effective approach for reducing hospital stay and morbidity following major colonic surgery.
