Abstract
Introduction
The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures.
Future strategies
However, there are several possibilities for further improvement of most of the components of fast-track surgery, where surgical stress, fluid and pain management are key factors. There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology.
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References
Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617
Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198
Kehlet H (2008) Fast-track colorectal surgery. Lancet 371:791–793
Kehlet H (2009) Multimodal approach to postoperative recovery. Curr Opin Crit Care 15:355–358
Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440
Varadhan KK, Lobo DN, Ljungqvist O (2010) Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin 26:527–547
Grade M, Quintel M, Ghadimi M (2011) Standard perioperative management in gastrointestinal surgery. Langenbecks Arch Surg (in press)
Arsalani-Zadeh R, ElFadl D, Yassin N, MacFie J (2011) Evidence-based review of enhancing postoperative recovery after breast surgery. Br J Surg 98:181–196
Lv D, Wang X, Shi G (2010) Perioperative enhanced recovery programmes for gynaecological cancer patients. Cochrane Database Syst Rev (6):CD008239
Kehlet H, Wilmore DW (2010) Surgical care—how can new evidence be applied to clinical practice? Colorectal Dis 12:2–4
Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J (2011) Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. doi:10.1001/archsurg.2010.309
Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928
Carli F, Kehlet H, Baldini G, McRae K, Hemmerling T, Salinas F, Neal JM (2011) Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med 36:63–72
Ljungqvist O, Nygren J, Thorell A (2000) Insulin resistance and elective surgery. Surgery 128:757–760
Svanfeldt M, Thorell A, Hausel J, Soop M, Rooyackers O, Nygren J, Ljungqvist O (2007) Randomized clinical trial of the effect of preoperative oral carbohydrate treatment on postoperative whole-body protein and glucose kinetics. Br J Surg 94:1342–1350
Mathur S, Plank LD, McCall JL, Shapkov P, McIlroy K, Gillanders LK, Merrie AE, Torrie JJ, Pugh F, Koea JB, Bissett IP, Parry BR (2010) Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery. Br J Surg 97:485–494
Wang ZG, Wang Q, Wang WJ, Qin HL (2010) Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg 97:317–327
Soop M, Carlson GL, Hopkinson J, Clarke S, Thorell A, Nygren J, Ljungqvist O (2004) Randomized clinical trial of the effects of immediate enteral nutrition on metabolic responses to major colorectal surgery in an enhanced recovery protocol. Br J Surg 91:1138–1145
Kehlet H (2007) Glucocorticoids for peri-operative analgesia: how far are we from general recommendations? Acta Anaesthesiol Scand 51:1133–1135
Lunn TH, Kristensen BB, Andersen LO, Husted H, Otte KS, Gaarn-Larsen L, Kehlet H (2011) Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial. Br J Anaesth 106:230–238
Kirdak T, Yilmazlar A, Cavun S, Ercan I, Yilmazlar T (2008) Does single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial. Am Surg 74:160–167
Zargar-Shoshtari K, Sammour T, Kahokehr A, Connolly AB, Hill AG (2009) Randomized clinical trial of the effect of glucocorticoids on peritoneal inflammation and postoperative recovery after colectomy. Br J Surg 96:1253–1261
Vignali A, Di PS, Orsenigo E, Ghirardelli L, Radaelli G, Staudacher C (2009) Effect of prednisolone on local and systemic response in laparoscopic vs. open colon surgery: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 52:1080–1088
Schmidt SC, Hamann S, Langrehr JM, Hoflich C, Mittler J, Jacob D, Neuhaus P (2007) Preoperative high-dose steroid administration attenuates the surgical stress response following liver resection: results of a prospective randomized study. J Hepatobiliary Pancreat Surg 14:484–492
Sammour T, Kahokehr A, Chan S, Booth RJ, Hill AG (2010) The humoral response after laparoscopic versus open colorectal surgery: a meta-analysis. J Surg Res 164:28–37
Fischer M, Matsuo K, Gonen M, Grant F, Dematteo RP, D'Angelica MI, Mascarenhas J, Brennan MF, Allen PJ, Blumgart LH, Jarnagin WR (2010) Relationship between intraoperative fluid administration and perioperative outcome after pancreaticoduodenectomy: results of a prospective randomized trial of acute normovolemic hemodilution compared with standard intraoperative management. Ann Surg 252:952–958
Mayer J, Boldt J, Mengistu AM, Rohm KD, Suttner S (2010) Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Crit Care 14:R18
Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R, Pradl R, Stepan M (2010) Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care 14:R118
Hamilton MA, Cecconi M, Rhodes A (2010) A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. doi:10.1213/ANE.0b013e3181eeaae5
Srinivasa S, Taylor MH, Sammour T, Kahokehr AA, Hill AG (2011) Oesophageal Doppler-guided fluid administration in colorectal surgery: critical appraisal of published clinical trials. Acta Anaesthesiol Scand 55:4–13
White PF, Kehlet H (2010) Improving postoperative pain management: what are the unresolved issues? Anesthesiology 112:220–225
Dahl JB, Mathiesen O, Kehlet H (2010) An expert opinion on postoperative pain management, with special reference to new developments. Expert Opin Pharmacother 11:2459–2470
Kehlet H, Andersen LØ (2011) High-volume, local infiltration analgesia in major joint replacement—what is the evidence and recommendations for clinical practice? Acta Anaesthesiol Scand (in press)
Freise H, Fischer LG (2009) Intestinal effects of thoracic epidural anesthesia. Curr Opin Anaesthesiol 22:644–648
Levy BF, Tilney HS, Dowson HM, Rockall TA (2010) A systematic review of postoperative analgesia following laparoscopic colorectal surgery. Colorectal Dis 12:5–15
Bundgaard-Nielsen M, Jorgensen CC, Jorgensen TB, Ruhnau B, Secher NH, Kehlet H (2009) Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth 102:756–762
Muller RG, Bundgaard-Nielsen M, Kehlet H (2010) Orthostatic function and the cardiovascular response to early mobilization after breast cancer surgery. Br J Anaesth 104:298–304
Werner MU, Mjobo HN, Nielsen PR, Rudin A (2010) Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology 112:1494–1502
Kehlet H (2008) Postoperative ileus—an update on preventive techniques. Nat Clin Pract Gastroenterol Hepatol 5:552–558
Augestad KM, Delaney CP (2010) Postoperative ileus: impact of pharmacological treatment, laparoscopic surgery and enhanced recovery pathways. World J Gastroenterol 16:2067–2074
de Castro SM, van den Esschert JW, van Heek NT, Dalhuisen S, Koelemay MJ, Busch OR, Gouma DJ (2008) A systematic review of the efficacy of gum chewing for the amelioration of postoperative ileus. Dig Surg 25:39–45
Noble EJ, Harris R, Hosie KB, Thomas S, Lewis SJ (2009) Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg 7:100–105
Hendry PO, van Dam RM, Bukkems SF, McKeown DW, Parks RW, Preston T, Dejong CH, Garden OJ, Fearon KC (2010) Randomized clinical trial of laxatives and oral nutritional supplements within an enhanced recovery after surgery protocol following liver resection. Br J Surg 97:1198–1206
Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L (2010) Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 24:653–661
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133:381S–453S
Husted H, Otte KS, Kristensen BB, Orsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605
Krenk L, Rasmussen LS (2011) Postoperative delirium and POCD in the elderly—what are the differences? Minerva Anestesiol (in press)
Maze M, Cibelli M, Grocott HP (2008) Taking the lead in research into postoperative cognitive dysfunction. Anesthesiology 108:1–2
Krenk L, Rasmussen LS, Kehlet H (2010) New insights into the pathophysiology of postoperative cognitive dysfunction. Acta Anaesthesiol Scand 54:951–956
Kehlet H (2009) Surgery: a midline or transverse abdominal incision? Nat Rev Gastroenterol Hepatol 6:571–572
Kehlet H, Kennedy RH (2006) Laparoscopic colonic surgery—mission accomplished or work in progress? Colorectal Dis 8:514–517
Kehlet H, Mythen M (2011) Why is the surgical high-risk patient still at risk? Br J Anaesth 106:289–291
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Kehlet, H. Fast-track surgery—an update on physiological care principles to enhance recovery. Langenbecks Arch Surg 396, 585–590 (2011). https://doi.org/10.1007/s00423-011-0790-y
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DOI: https://doi.org/10.1007/s00423-011-0790-y