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.

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.