Abstract
Fast-track surgery is an interdisciplinary multimodal concept of minimally invasive surgery or new incision lines and “cutting old plaits” (e.g., the use of drains or tubes). It uses modern intraoperative anesthesia (e.g., fluid restriction) and analgesia, including new drugs and novel ways of administration (e.g., thoracic epidural analgesia) for postoperative pain relief, in combination with the immediate mobilization of the patient and early oral nutrition after the operation. This approach requires a cooperating team of motivated nurses, physiotherapists, anesthesiologists, and surgeons, in addition to continuous improvement of the processes involved. Moreover, extended patient education and information about the procedures and the expected time course are of the highest importance, as the active role of the patient is to be emphasized. This chapter describes the development and implementation of fast-track surgery in colorectal diseases at the Department of Surgery of the University Hospital of Heidelberg, Germany. Preliminary results of fast-track surgery suggest a significant and clear overall benefit for the patient. A shorter hospital stay and reduced systemic morbidity in addition to no increase in postoperative complications on an out-patient basis were found. However, to exclude a “bloody discharge” of the patients, thorough follow-up and quality control are mandatory. Although in the initial phase increased personnel care is necessary, in the new German reimbursement system with G-DRGs (German diagnosis-related groups) fast-track surgery seems to save resources in the long term.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Pearson SD, Goulart-Fisher D, Lee TH (1995) Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med 123:941–948
Archer SB, Burnett RJ, Flesch LV, Hobler SC, Bower RH, Nussbaum MS, Fischer JE (1997) Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch/anal anastomosis. Surgery 122:699–703; discussion 703–705
Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87:1480–1493
Chen HH, Wexner SD, Weiss EG, Nogueras JJ, Alabaz O, Iroatulam AJ, Nessim A, Joo JS (1998) Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy. Surg Endosc 12:1397–1400
Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, Feinglass NG, Metzger PP, Fulmer JT, Smith SL (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 83:757–765
Tramer MR, Moore RA, Reynolds DJ, McQuay HJ (1997) A quantitative systematic review of ondansetron in treatment of established postoperative nausea and vomiting. Bmj 314:1088–1092
Henzi I, Walder B, Tramer MR (2000) Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 90:186–194
Henzi I, Sonderegger J, Tramer MR (2000) Efficacy, dose-response, and adverse effects of droperidol for prevention of postoperative nausea and vomiting. Can J Anaesth 47:537–551
Burke P, Mealy K, Gillen P, Joyce W, Traynor O, Hyland J (1994) Requirement for bowel preparation in colorectal surgery. Br J Surg 81:907–910
Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg 87:1540–1545
Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH (2001) 'Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538
Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86:227–230
Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jorgensen P (2003) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev CD001544
Petrelli NJ, Stulc JP, Rodriguez-Bigas M, Blumenson L (1993) Nasogastric decompression following elective colorectal surgery: a prospective randomized study. Am Surg 59:632–635
Manning BJ, Winter DC, McGreal G, Kirwan WO, Redmond HP (2001)Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy. Surgery 130:788–791
Yoo CH, Son BH, Han WK, Pae WK (2002) Nasogastric decompression is not necessary in operations for gastric cancer: prospective randomised trial. Eur J Surg 168:379–383
Cheatham ML, Chapman WC, Key SP, Sawyers JL (1995) A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 221:469–76; discussion 476–478
Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1493
Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, Beattie C (1997) Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA 277:1127–1134
Merad F, Yahchouchi E, Hay JM, Fingerhut A, Laborde Y, Langlois-Zantain O (1998) Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research Arch Surg 133:309–314
Urbach DR, Kennedy ED, Cohen MM (1999) Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 229:174–180
Benoist S, Panis Y, Denet C, Mauvais F, Mariani P, Valleur P (1999) Optimal duration of urinary drainage after rectal resection: a randomized controlled trial. Surgery 125:135–141
Basse L, Werner M, Kehlet H (2000) Is urinary drainage necessary during continuous epidural analgesia after colonic resection? Reg Anesth Pain Med 25:498–501
Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232:51–57
Bokey EL, Moore JW, Chapuis PH, Newland RC (1996) Morbidity and mortality following laparoscopic-assisted right hemicolectomy for cancer. Dis Colon Rectum 39:S24–S28
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Kremer, M., Ulrich, A., Büchler, M., Uhl, W. (2005). Fast-Track Surgery: The Heidelberg Experience. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_3
Download citation
DOI: https://doi.org/10.1007/3-540-27449-9_3
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-23341-1
Online ISBN: 978-3-540-27449-0
eBook Packages: MedicineMedicine (R0)