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Published in: Journal of Gastrointestinal Surgery 4/2014

01-04-2014 | Original Article

A Comparative Study of ‘Fast-Track’ Versus Traditional Peri-Operative Care Protocols in Gastrointestinal Surgeries

Authors: Aditya J. Nanavati, S. Prabhakar

Published in: Journal of Gastrointestinal Surgery | Issue 4/2014

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Abstract

Introduction

A ‘fast-track protocol’ in surgery suggests the application of evidence-based practices to expedite patient recovery. It has shown to reduce hospital stay, hasten recovery as well as facilitate earlier return to work. It has a considerable impact in reducing healthcare costs. The basic tenet is to treat the patient’s disease by minimal disturbance of their physiology. The protocol encompasses pre-operative, intra-operative and post-operative interventions which when carried out together would show maximal benefits. The surgeon is usually the leader of the team managing the patient, but it cannot be over-emphasised that this is a multi-disciplinary team approach.

Materials and Methods

We conducted a prospective interventional study to investigate whether ‘fast-track’ surgery protocols improve patient outcome when compared to traditional peri-operative care followed at our institute. By doing so, we observed that the patients who underwent ‘fast tracking’ required lesser analgesia, had earlier ambulation, earlier return of intestinal motility, were free from tubes, catheters and drains earlier and lastly were discharged earlier. This was achieved without a rise in complications or re-admissions.

Results/Conclusion

The results have proved that implementing the fast-track protocol for gastrointestinal surgeries is not only safe and effective, but also improves patient outcome.
Literature
1.
go back to reference Kehlet H, Wilmore D W. Multimodal strategies to improve surgical income. Am J Surg.2002; 183:630–641.PubMedCrossRef Kehlet H, Wilmore D W. Multimodal strategies to improve surgical income. Am J Surg.2002; 183:630–641.PubMedCrossRef
2.
go back to reference Ansari D, Gianotti L, Schroder J, Andersson R. Fast-track surgery: procedure-specific aspects and future direction. Langenbecks Arch Surg. 2013 Jan; 398(1):29–37. Ansari D, Gianotti L, Schroder J, Andersson R. Fast-track surgery: procedure-specific aspects and future direction. Langenbecks Arch Surg. 2013 Jan; 398(1):29–37.
3.
go back to reference Scharfenberg M, Raue W, Junghans T, Schwenk W. "Fast-track" rehabilitation after colonic surgery in elderly patients–is it feasible? Int J Colorectal Dis 2007; 22(12):1469–74. Scharfenberg M, Raue W, Junghans T, Schwenk W. "Fast-track" rehabilitation after colonic surgery in elderly patients–is it feasible? Int J Colorectal Dis 2007; 22(12):1469–74.
4.
5.
go back to reference Kratzing C, Pre-operative nutrition and carbohydrate loading. Proc Nutr Soc. 2011; 70(3):311–315.PubMedCrossRef Kratzing C, Pre-operative nutrition and carbohydrate loading. Proc Nutr Soc. 2011; 70(3):311–315.PubMedCrossRef
6.
go back to reference Iancu C, Mocan LC, Todea-Iancu D, Mocan T, Acalovschi I, Ionescu D, Zaharie FV, Osian G, Puia CI, Muntean V. Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointestin Liver Dis 2008; 17(3):299–303.PubMed Iancu C, Mocan LC, Todea-Iancu D, Mocan T, Acalovschi I, Ionescu D, Zaharie FV, Osian G, Puia CI, Muntean V. Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointestin Liver Dis 2008; 17(3):299–303.PubMed
7.
go back to reference Svanfeldt M, Thorell A, Hausel J, Soop M, Rooyackers O, Nygren J, Ljungqvist O. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. British J Surg 2007; 94(11):1342–50.CrossRef Svanfeldt M, Thorell A, Hausel J, Soop M, Rooyackers O, Nygren J, Ljungqvist O. Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. British J Surg 2007; 94(11):1342–50.CrossRef
8.
go back to reference Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Diseases 2006; 8(7):563–9.CrossRef Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Diseases 2006; 8(7):563–9.CrossRef
9.
go back to reference Buscher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg. 2004 Dec; 139(12):1359–64. Buscher P, Mermillod B, Gervaz P, Morel P. Mechanical bowel preparation for elective colorectal surgery: a meta-analysis. Arch Surg. 2004 Dec; 139(12):1359–64.
10.
go back to reference Brady M, Kinn S, Stuart P: Preoperative fasting for adults to prevent perioperative complications: Cochrane Database Syst Rev2003CD004423. Brady M, Kinn S, Stuart P: Preoperative fasting for adults to prevent perioperative complications: Cochrane Database Syst Rev2003CD004423.
11.
go back to reference Basse L, Jakobsen DH, Billesbole P, Werner M, Kehlet H. A Clinical Pathway to Accelerate Recovery after Colonic Resection. Ann Surg 2000; 232(1):51–57.PubMedCentralPubMedCrossRef Basse L, Jakobsen DH, Billesbole P, Werner M, Kehlet H. A Clinical Pathway to Accelerate Recovery after Colonic Resection. Ann Surg 2000; 232(1):51–57.PubMedCentralPubMedCrossRef
12.
go back to reference Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med May 9 1996; 334(19):1209–15. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med May 9 1996; 334(19):1209–15.
13.
go back to reference Macrae HM, Mcleod RS. Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 1998 Feb; 41(2):180–9. Macrae HM, Mcleod RS. Handsewn vs. stapled anastomoses in colon and rectal surgery: a meta-analysis. Dis Colon Rectum 1998 Feb; 41(2):180–9.
14.
go back to reference Satoru S, Yamagishi H, Taji Y, Shimada T and Noguchi Y. Single- versus two-layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg 2006 Jan 27; 6:2. Satoru S, Yamagishi H, Taji Y, Shimada T and Noguchi Y. Single- versus two-layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg 2006 Jan 27; 6:2.
15.
go back to reference Li MZ, Xiao LB, Wu WH, Yang SB, Li SZ. Meta-analysis of laparoscopic versus open colorectal surgery within fast-track perioperative care. Dis Colon Rectum 2012 Jul; 55(7):821–7 Li MZ, Xiao LB, Wu WH, Yang SB, Li SZ. Meta-analysis of laparoscopic versus open colorectal surgery within fast-track perioperative care. Dis Colon Rectum 2012 Jul; 55(7):821–7
17.
18.
go back to reference Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg. 2002 Sep; 95(3):627–34. Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg. 2002 Sep; 95(3):627–34.
19.
20.
go back to reference Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag 2008 Oct; 4(5):913–7. Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag 2008 Oct; 4(5):913–7.
21.
go back to reference Hodgson PS, Liu SS . Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion. Best Practice & Research Clinical Anaesthesiology 1999; 13(1):9–22.CrossRef Hodgson PS, Liu SS . Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion. Best Practice & Research Clinical Anaesthesiology 1999; 13(1):9–22.CrossRef
22.
go back to reference Browning L, Denehy L, Scholes RL: The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Aust J Physiother 2007 53:47, 52. Browning L, Denehy L, Scholes RL: The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Aust J Physiother 2007 53:47, 52.
23.
go back to reference Nelson R, Edwards S, Tse B: Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007, CD004929. Nelson R, Edwards S, Tse B: Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev 2007, CD004929.
24.
go back to reference Karliczek A, Jesus EC, Matos D: Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis 2006 8:259, 65. Karliczek A, Jesus EC, Matos D: Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis 2006 8:259, 65.
25.
go back to reference Lewis SJ, Egger M, Sylvester P, Thomas SA. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001; 323(7316):773. Lewis SJ, Egger M, Sylvester P, Thomas SA. Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ 2001; 323(7316):773.
26.
go back to reference Andersen HK, Lewis SJ, Thomas S: Early enteral nutrition within 24 h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006 Andersen HK, Lewis SJ, Thomas S: Early enteral nutrition within 24 h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev 2006
27.
go back to reference Henriksen MG, Hansen HV, Hessov I: Early oral nutrition after elective colorectal surgery: influence of balanced analgesia and enforced mobilization. Nutrition 2002 18:263, 7. Henriksen MG, Hansen HV, Hessov I: Early oral nutrition after elective colorectal surgery: influence of balanced analgesia and enforced mobilization. Nutrition 2002 18:263, 7.
28.
go back to reference Contant CM, Hop WC, van't Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, Neijenhuis PA, Idenburg FJ, Dijkhuis CM, Heres P, van Tets WF, Gerritsen JJ,Weidema WF.. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 2007; 370:2112–2117. Contant CM, Hop WC, van't Sant HP, Oostvogel HJ, Smeets HJ, Stassen LP, Neijenhuis PA, Idenburg FJ, Dijkhuis CM, Heres P, van Tets WF, Gerritsen JJ,Weidema WF.. Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial. Lancet 2007; 370:2112–2117.
29.
go back to reference Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis 2012 Dec; 27(12):1549–54. Lv L, Shao YF, Zhou YB. The enhanced recovery after surgery (ERAS) pathway for patients undergoing colorectal surgery: an update of meta-analysis of randomized controlled trials. Int J Colorectal Dis 2012 Dec; 27(12):1549–54.
Metadata
Title
A Comparative Study of ‘Fast-Track’ Versus Traditional Peri-Operative Care Protocols in Gastrointestinal Surgeries
Authors
Aditya J. Nanavati
S. Prabhakar
Publication date
01-04-2014
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 4/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-013-2403-2

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