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"Fast-track" rehabilitation for elective colonic surgery in Germany--prospective observational data from a
W Schwenk1, N Günther, P Wendling
1General-, Visceral-, Vascular- and Thoracic Surgery, Charité Campus Mitte, Universitymedicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. wolfgang.schwenk@charite.de
Background:
The results of "Fast-track" colonic surgery in an unselected population outside of specialised units has been unknown yet.
Materials And Methods:
Data from 24 German hospitals performing "Fast-track" rehabilitation as the standard peri-operative care for patients undergoing elective colonic resection were collected in a prospective multi-centre study conducted between April 2005 and September 2006 to evaluate local and general morbidity.
Results:
One thousand and forty-seven patients undergoing elective "fast-track" colonic resection were included. Compliance to essential parts of "fast-track" rehabilitation was high (epidural analgesia 86,6%, early oral feeding and mobilisation on the day of surgery 85.5 and 85.4%). Surgical morbidity was observed in 148 patients (14.1%) and general morbidity in 95 patients (9.1%), while mortality was 0.8%. Predefined discharge criteria were met within 5 (1-83) days after surgery, but because of economical restraints in the German DRG system, patients were discharged only after 8 (3-83) days. Re-admission rate was 3.9%.
Conclusion:
"Fast-track" rehabilitation for elective colonic resection was safe and feasible in German hospitals of all sizes and yielded a low general morbidity and re-admission rate. Post-operative recovery was enhanced, but discharge from hospital was delayed because of economical reasons.
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