Insights into fast-track colon surgery: a plea for a tailored program

Pellegrino, Lucas;Lois, Fernande;Remue, Christophe;Forget, Patrice;Kartheuser, Alex;et.al.
(2013) Surgical Endoscopy : surgical and interventional techniques — Vol. 27, n° 4, p. 1178-1185 (2013)

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Authors
  • Pellegrino, LucasUCLouvain
    Author
  • Lois, FernandeUCLouvain
    Author
  • Remue, Christopheorcid-logoUCLouvain
    Author
  • Forget, PatriceUCLouvain
    Author
  • Crispin, BrigitteUCLouvain
    Author
  • Léonard, DanielUCLouvain
    Author
  • Jamart, JacquesUCLouvain
    Author
  • Kartheuser, AlexUCLouvain
    Author
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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.
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Pellegrino, L., Lois, F., Remue, C., Forget, P., Crispin, B., Léonard, D., Jamart, J., & Kartheuser, A. (2013). Insights into fast-track colon surgery: a plea for a tailored program. Surgical Endoscopy : surgical and interventional techniques, 27(4), 1178-1185. https://doi.org/10.1007/s00464-012-2572-1 (Original work published 2013)