Open Access‘Fast‐track’ protocols in colorectal surgery
Author(s) -
SENAGORE ANTHONY J.
Publication year - 2007
Publication title -
transfusion alternatives in transfusion medicine
Language(s) - English
Resource type - Journals
eISSN - 1778-428X
pISSN - 1295-9022
DOI - 10.1111/j.1778-428x.2007.00049.x
Subject(s) - medicine , fast track , colorectal surgery , ileus , colectomy , nausea , vomiting , rehabilitation , perioperative , surgery , anesthesia , general surgery , intensive care medicine , abdominal surgery , physical therapy , colorectal cancer , cancer
SUMMARY A greater appreciation of newer concepts in healthcare process management, improved understanding of postoperative physiology, and economic pressures have combined to produce safe reductions of hospital stays after major gastrointestinal surgery. Preoperative and postoperative education is a key component of successful fast‐track care pathways. Effective treatment of pain, nausea and vomiting, ileus, and fatigue combined with minimization of mechanical factors all decrease stress‐induced organ dysfunction. An important factor leading to enhanced recovery is early ambulation, which maintains muscle strength, limits disruption of orthostatic reflexes, and plays a role in reducing ileus and pulmonary complications. A growing body of evidence supports the contention that laparoscopic colectomy may allow optimization of fast‐track care of the colectomy patients. Epidural anesthesia/analgesia appears to be an important component of the perioperative care plan in many fast‐track programs. Evaluation of an enhanced care plan called the ‘Controlled Rehabilitation and Early Ambulation and Diet’ showed that patients who were suitable for the program at the time of surgery stayed in hospital for 4.3 ± 1.6 days postoperatively. The presence of a defunctioning loop ileostomy, or a history of previous abdominal surgery did not affect time to discharge. Time to discharge from hospital was significantly delayed in patients who showed poor compliance with the protocol. The process of care was effective in patients undergoing colonic, rectal and reoperative surgery, not just the ‘optimal’ colectomy patient.