TY - JOUR
T1 - Insights into fast-track colon surgery
T2 - A plea for a tailored program
AU - Pellegrino, L.
AU - Lois, F.
AU - Remue, C.
AU - Forget, P.
AU - Crispin, B.
AU - Leonard, D.
AU - Jamart, J.
AU - Kartheuser, A.
N1 - Acknowledgments
The authors thank the whole “Fast-Track” team of the St-Luc Hospital in Brussels for their invaluable assistance and Prof. C. Craddock-de Burbure for revising the manuscript.
PY - 2013/4
Y1 - 2013/4
N2 - Background
This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay.
Design
This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression.
Results
Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001).
Conclusions
The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.
AB - Background
This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay.
Design
This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression.
Results
Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001).
Conclusions
The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.
KW - Fast-track surgery
KW - ERAS
KW - Colorectal surgery
KW - Laparoscopy
KW - Length of hospital stay
KW - Postoperative complications
UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-84876297630&partnerID=MN8TOARS
U2 - 10.1007/s00464-012-2572-1
DO - 10.1007/s00464-012-2572-1
M3 - Article
VL - 27
SP - 1178
EP - 1185
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
IS - 4
ER -