C van Beekum1, B Stoffels2, M von Websky2, J-P Ritz3, B Stinner4, S Post5, W Schwenk6, J C Kalff2, T O Vilz2. 1. Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. cornelius.vanbeekum@ukbonn.de. 2. Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. 3. Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Deutschland. 4. Klinik für Viszeral‑, Thorax- und Gefäßchirurgie, Elbe Klinikum Stade, Stade, Deutschland. 5. Chirurgische Klinik (Direktor Emeritus), Universitätsmedizin Mannheim, Mannheim, Deutschland. 6. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Städtisches Klinikum Solingen, Solingen, Deutschland.
Abstract
BACKGROUND: For more than a decade the evolving concept of fast track surgery has been implemented, predominantly in colorectal surgery. The practice of fast track surgery has yielded excellent results concerning reduction of postoperative complications and hospital stay and has been shown to increase patient satisfaction; however, several studies have shown a sometimes alarmingly low rate of implementation of the individual fast track measures and the rate is a maximum of 44%. OBJECTIVE: In this review, obstacles for implementation of fast track surgery are investigated. Advice is given on possible solutions to circumvent obstacles and facilitate successful establishment of multimodal recovery protocols in individual institutions. MATERIAL AND METHODS: The current international literature is critically evaluated and discussed with a particular focus on prospective clinical trials and expert recommendations. RESULTS: The reasons for a lack of adherence to fast track surgery principles have been shown to be multifactorial. Time-consuming expenditure, logistic difficulties, lack of support by colleagues as well as limitations in the healthcare system and patient-dependent factors appear to complicate implementation of fast track programs. CONCLUSION: Successful implementation and long-term perpetuation can be achieved only by an interdisciplinary team with a low level hierarchy, continuous training and a positive feedback culture. An early inclusion and clarification of personnel and patients should be firmly integrated into the fast track concept. This results in a higher satisfaction of patients and personnel and subsequently stronger adherence to the fast track concept.
BACKGROUND: For more than a decade the evolving concept of fast track surgery has been implemented, predominantly in colorectal surgery. The practice of fast track surgery has yielded excellent results concerning reduction of postoperative complications and hospital stay and has been shown to increase patient satisfaction; however, several studies have shown a sometimes alarmingly low rate of implementation of the individual fast track measures and the rate is a maximum of 44%. OBJECTIVE: In this review, obstacles for implementation of fast track surgery are investigated. Advice is given on possible solutions to circumvent obstacles and facilitate successful establishment of multimodal recovery protocols in individual institutions. MATERIAL AND METHODS: The current international literature is critically evaluated and discussed with a particular focus on prospective clinical trials and expert recommendations. RESULTS: The reasons for a lack of adherence to fast track surgery principles have been shown to be multifactorial. Time-consuming expenditure, logistic difficulties, lack of support by colleagues as well as limitations in the healthcare system and patient-dependent factors appear to complicate implementation of fast track programs. CONCLUSION: Successful implementation and long-term perpetuation can be achieved only by an interdisciplinary team with a low level hierarchy, continuous training and a positive feedback culture. An early inclusion and clarification of personnel and patients should be firmly integrated into the fast track concept. This results in a higher satisfaction of patients and personnel and subsequently stronger adherence to the fast track concept.
Entities:
Keywords:
Colorectal Surgery; Compliance; Fast Track Surgery; Introduction; Obstacles; Perioperative medicine
Authors: Ruben van Zelm; Ellen Coeckelberghs; Walter Sermeus; Anthony De Buck van Overstraeten; Arved Weimann; Deborah Seys; Massimiliano Panella; Kris Vanhaecht Journal: Int J Colorectal Dis Date: 2017-07-17 Impact factor: 2.571
Authors: Alexander B. Stone; Christina T. Yuan; Michael A. Rosen; Michael C. Grant; Lauren E. Benishek; Elizabeth Hanahan; Lisa H. Lubomski; Clifford Ko; Elizabeth C. Wick Journal: JAMA Surg Date: 2018-03-01 Impact factor: 14.766