Perceptions of the application of fast-track surgical principles by general surgeons

Fast-track surgery is a novel approach which uses a multimodal package of changes to traditional surgical care to reduce the stress response evoked by surgery allowing for enhanced recovery times. The depth of understanding and application of fast-track principles to general surgical practice by consultant surgeons is unknown.

'Core management features' central to published fast-track general surgical studies were identified following a comprehensive Medline literature search. The knowledge and application of these features were examined in a postal questionnaire sent to 116 general surgeons in a single region.

Of respondents, 31% indicated they were currently using fast-track surgery (the 'fast-trackers'). The number of fast-track compliant responses was calculated for each consultant (range, 1-12 of 14). Mean scores for 'fast-trackers' of 8.45 (+/- 2.188) and 'non-fast-trackers' of 6.16 (+/- 2.352) showed no significant differences (P > 0.6). The 'fast-trackers' median estimated length of stay (LOS) was 5 days (inter-quartile range [IQR], 4-7) which was significantly lower than the 7 day (IQR 6-8) LOS estimates given by the 'non-fast-trackers' (P < 0.01).

Despite estimating reduced LOS, no significant difference in total fast-track compliant responses was found between the 'fast-tracker' and 'non-fast-tracker' groups. The 'fast-trackers' estimated LOS of 5 days is 2.5 times the 2 day LOS reported in the published fast-track studies. A significant gap exists between the perception and realisation of fast-track methodology amongst general surgeons.