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Fast-Track-Rehabilitation in der Viszeralchirurgie

Fast track rehabilitation in visceral surgery

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Zusammenfassung

Unter „Fast-Track-Rehabilitation“ versteht man in der Allgemein- und Viszeralchirurgie einen prozedurenspezifischen, evidenzbasierten, multimodalen, interprofessionellen und patientenzentrierten klinischen Behandlungspfad zur perioperativen Therapie. Primäre Ziele der Fast-Track-Rehabilitation sind die Erhaltung von Autonomie und Homöostase des Patienten, die Minimierung postoperativer Organdysfunktionen und dadurch die Vermeidung allgemeiner postoperativer Komplikationen. Gleichzeitig wird die postoperative Genesung der Patienten derart beschleunigt, dass eine frühzeitige Entlassung aus dem Krankenhaus möglich wird. 14 Jahre nach der Erstbeschreibung eines klinischen Behandlungspfades zur Fast-Track-Rehabilitation bei elektiven Kolonresektionen durch den dänischen Chirurgen Henrik Kehlet und seine Mitarbeiter liegen derartige Fast-Track-Rehabilitationskonzepte für alle häufigen Operationen in der Allgemein- und Viszeralchirurgie vor. Patienteninformation und -schulung, präoperative Risikooptimierung, evidenzbasierte Operationsvorbereitung, moderne Narkoseführung und Schmerztherapie, Verzicht auf Sonden, Drainagen und Katheter, rasche orale oder enterale Ernährung und die forcierte Mobilisation sind die wesentlichen Prinzipien der Fast-Track-Rehabilitation. Die Einführung evidenzbasierter Fast-Track-Behandlungspfade führt für Ärzte und Pflegepersonal zu erheblichen Veränderungen gewohnter traditioneller Verhaltensweisen und muss daher durch intensive Kommunikation und Schulung begleitet werden. Nur wenn alle beteiligten Berufsgruppen gleichermaßen an der Umsetzung derartiger Konzepte mitwirken, können diese anspruchsvollen Behandlungkonzepte im klinischen Alltag implementiert werden. Bislang waren dabei Viszeralchirurgen weltweit federführend, sodass die Fast-Track-Rehabilitation eine Chance darstellt, verlorengegangenen Boden auf dem Feld der perioperativen Medizin für die Viszeralchirurgie zurückzugewinnen. Eine intensive wissenschaftliche Auseinandersetzung mit der Fast-Track-Rehabilitation in experimenteller und klinischer Forschung ist daher für Viszeralchirurgen in Zukunft dringend geboten, um die chirurgische Kompetenz in der Diskussion mit benachbarten Fachdisziplinen zu erhalten.

Abstract

In general and visceral surgery fast-track rehabilitation means a procedure-specific, evidence-based, multimodal, interdisciplinary and patient-focussed clinical pathway in perioperative therapy. The primary goals of fast-track rehabilitation are to maintain patient autonomy and homeostasis, minimization of postoperative organ dysfunction and prevention of postoperative general morbidity (i.e. cardiopulmonary complications, nosocomial infections). At the same time, postoperative recovery is accelerated and early discharge from hospital after surgery becomes possible. Fast-track-pathways are now available for all common procedures in general and visceral surgery, 14 years after the first publication of a clinical fast-track pathway for patients undergoing elective colon resection by the Danish surgeon Henrik Kehlet and his co-workers. The main principles of fast-track rehabilitation are patient information and education, evidence-based preoperative preparation and risk minimization, modern anesthesia and analgesia, avoidance of drains and catheters, early postoperative oral or enteral feeding and forced mobilization. Introduction of clinical fast-track pathways will lead to profound changes from traditional to evidence-based behavior of physicians and nursing personnel. Therefore, implementation of fast-track programs should be accompanied by intensive education and collaboration of all professional groups concerned with perioperative patient care. So far, visceral surgeons have been leading the field of fast-track rehabilitation and fast-track could be a way for surgeons to recapture lost ground in perioperative medicine. Therefore, intensive experimental and clinical research in fast-track rehabilitation is strongly recommended for visceral surgeons to maintain competence in scientific discussions with other medical specialists.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor war als Referent für die Firmen Astra-Zeneca, Bristol-Myers-Squibb, Pfizer und Múndipharma tätig.

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  1. Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland

    W. Schwenk

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Correspondence to W. Schwenk.

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Schwenk, W. Fast-Track-Rehabilitation in der Viszeralchirurgie. Chirurg 80, 690–701 (2009). https://doi.org/10.1007/s00104-009-1676-1

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