Changes in outcome during implementation of a fast-track colonic surgery project in a university-affiliated general teaching hospital: advantages reached with ERAS (Enhanced Recovery After Surgery project) over a 1-year period

Dig Surg. 2008;25(5):335-8. doi: 10.1159/000158910. Epub 2008 Oct 1.

Abstract

Background and aims: The aim of this study was to investigate whether changes can be accomplished rapidly after implementing a fast-track colonic surgery project at a university-affiliated general teaching hospital.

Methods: In 2004 and 2005 all colonic surgery patients were recorded for a number of pre-, per- and postoperative care elements. In 2006, during the implementation of a fast-track program, changes were recorded.

Results: Before the implementation of the fast-track regime at our hospital, 97% of the patients (n = 89/92) received mechanical bowel preparation, in contrast to 3% (n = 1/36) afterwards (p < 0.0001). The application of thoracic epidural analgesia rose from 46% (n = 42/92) in 2004 and 2005 to 94% (n = 34/36) in 2006 (p < 0.0001). The use of nasogastric tubes postoperatively almost disappeared. 77% (n = 28/36) enjoyed a small meal on the 1st day after operation, compared to 0% (n = 0/92) in 2004 and 2005 (p < 0.0001). Median hospital stay was 6 (range 3-27) nights in 2006 compared to 9 (range 3-25) nights in 2005 and 9.5 (range 7-64) nights in 2004 (p < 0.005).

Conclusion: These preliminary results show that also at a district general teaching hospital advantages can be reached rapidly and safely by implementing fast-track surgery; especially a faster recovery.

Publication types

  • Comparative Study

MeSH terms

  • Analgesia, Epidural / methods
  • Colectomy / methods
  • Colectomy / rehabilitation*
  • Colonic Diseases / rehabilitation*
  • Colonic Diseases / surgery*
  • Colonic Neoplasms / rehabilitation
  • Colonic Neoplasms / surgery
  • Critical Pathways*
  • Eating
  • Elective Surgical Procedures / rehabilitation
  • Enema / statistics & numerical data
  • Feasibility Studies
  • Female
  • Hospitals, Teaching*
  • Hospitals, University
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Perioperative Care / methods
  • Postoperative Care / methods
  • Preoperative Care / methods
  • Recovery of Function
  • Retrospective Studies
  • Treatment Outcome