BACKGROUND: Enhanced perioperative care programs have been developed in order to attenuate the impact of surgical stress on organ dysfunction, thereby accelerating hospital discharge and reducing morbidity. The implementation of a fast-track program for laparoscopic colorectal surgery is reported. METHODS: We report on a series of patients who entered a coordinated program based on preoperative patient education and counseling, a laparoscopic approach, provision of postoperative epidural analgesia, early food intake and mobilization, and structured surgical and nursing care practices. The program was introduced in September 2006 and adapted to our institutional needs. Outcome measures included length of hospital stay, return of bowel function, incidences of postoperative complications, and rate of readmission to hospital. RESULTS: Twenty-five patients were selected by the surgeons for the accelerated laparoscopic colorectal pathway. The median duration of hospital stay was 3 (95% confidence interval, 3-4) days. Sixteen patients (64%) were discharged from hospital on day 3. Nine patients failed the pathway for various reasons (social indications, poor pain relief, wound infection, anemia, urinary retention) and were discharged later (six patients on day 4, two patients on day 5, and one patient on day 6). Times to recover bowel function and to resume a full diet were all within the first 36 hr from time of surgery. There were two readmissions. CONCLUSION: This early clinical experience demonstrates the feasibility of a fast-track program for colonic surgery and the requirement for an integrated multidisciplinary approach to perioperative care.
BACKGROUND: Enhanced perioperative care programs have been developed in order to attenuate the impact of surgical stress on organ dysfunction, thereby accelerating hospital discharge and reducing morbidity. The implementation of a fast-track program for laparoscopic colorectal surgery is reported. METHODS: We report on a series of patients who entered a coordinated program based on preoperative patient education and counseling, a laparoscopic approach, provision of postoperative epidural analgesia, early food intake and mobilization, and structured surgical and nursing care practices. The program was introduced in September 2006 and adapted to our institutional needs. Outcome measures included length of hospital stay, return of bowel function, incidences of postoperative complications, and rate of readmission to hospital. RESULTS: Twenty-five patients were selected by the surgeons for the accelerated laparoscopic colorectal pathway. The median duration of hospital stay was 3 (95% confidence interval, 3-4) days. Sixteen patients (64%) were discharged from hospital on day 3. Nine patients failed the pathway for various reasons (social indications, poor pain relief, wound infection, anemia, urinary retention) and were discharged later (six patients on day 4, two patients on day 5, and one patient on day 6). Times to recover bowel function and to resume a full diet were all within the first 36 hr from time of surgery. There were two readmissions. CONCLUSION: This early clinical experience demonstrates the feasibility of a fast-track program for colonic surgery and the requirement for an integrated multidisciplinary approach to perioperative care.
Authors: Nourah Alsharqawi; Mohsen Alhashemi; Pepa Kaneva; Gabriele Baldini; Julio F Fiore; Liane S Feldman; Lawrence Lee Journal: Surg Endosc Date: 2019-07-30 Impact factor: 4.584
Authors: Kristoffer Lassen; Marielle M E Coolsen; Karem Slim; Francesco Carli; José E de Aguilar-Nascimento; Markus Schäfer; Rowan W Parks; Kenneth C H Fearon; Dileep N Lobo; Nicolas Demartines; Marco Braga; Olle Ljungqvist; Cornelis H C Dejong Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: J Nygren; J Thacker; F Carli; K C H Fearon; S Norderval; D N Lobo; O Ljungqvist; M Soop; J Ramirez Journal: World J Surg Date: 2013-02 Impact factor: 3.352
Authors: Nicoleta O Kolozsvari; Giovanni Capretti; Pepa Kaneva; Amy Neville; Franco Carli; Sender Liberman; Patrick Charlebois; Barry Stein; Melina C Vassiliou; Gerald M Fried; Liane S Feldman Journal: Surg Endosc Date: 2012-07-19 Impact factor: 4.584
Authors: Chao Li; Francesco Carli; Lawrence Lee; Patrick Charlebois; Barry Stein; Alexander S Liberman; Pepa Kaneva; Berson Augustin; Mingkwan Wongyingsinn; Ann Gamsa; Do Jun Kim; Melina C Vassiliou; Liane S Feldman Journal: Surg Endosc Date: 2012-10-09 Impact factor: 4.584