Insights into fast-track colon surgery

A plea for a tailored program

L. Pellegrino, F. Lois, C. Remue, P. Forget, B. Crispin, D. Leonard, J. Jamart, A. Kartheuser* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)1178-1185
Number of pages8
JournalSurgical Endoscopy
Volume27
Issue number4
Early online date17 Oct 2012
DOIs
Publication statusPublished - Apr 2013

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Length of Stay
Colon
Perioperative Care
Rectal Diseases
Retrospective Studies
Laparoscopy
Laparotomy
Linear Models
Logistic Models
Mortality

Keywords

  • Fast-track surgery
  • ERAS
  • Colorectal surgery
  • Laparoscopy
  • Length of hospital stay
  • Postoperative complications

Cite this

Pellegrino, L., Lois, F., Remue, C., Forget, P., Crispin, B., Leonard, D., ... Kartheuser, A. (2013). Insights into fast-track colon surgery: A plea for a tailored program. Surgical Endoscopy, 27(4), 1178-1185. https://doi.org/10.1007/s00464-012-2572-1

Insights into fast-track colon surgery : A plea for a tailored program. / Pellegrino, L.; Lois, F.; Remue, C.; Forget, P.; Crispin, B.; Leonard, D.; Jamart, J.; Kartheuser, A. (Corresponding Author).

In: Surgical Endoscopy, Vol. 27, No. 4, 04.2013, p. 1178-1185.

Research output: Contribution to journalArticle

Pellegrino, L, Lois, F, Remue, C, Forget, P, Crispin, B, Leonard, D, Jamart, J & Kartheuser, A 2013, 'Insights into fast-track colon surgery: A plea for a tailored program', Surgical Endoscopy, vol. 27, no. 4, pp. 1178-1185. https://doi.org/10.1007/s00464-012-2572-1
Pellegrino, L. ; Lois, F. ; Remue, C. ; Forget, P. ; Crispin, B. ; Leonard, D. ; Jamart, J. ; Kartheuser, A. / Insights into fast-track colon surgery : A plea for a tailored program. In: Surgical Endoscopy. 2013 ; Vol. 27, No. 4. pp. 1178-1185.
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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.

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