[Multimodal rehabilitation programme in elective colorectal surgery. Development of a clinical pathway and...

Multimodal rehabilitation programmes enhance recovery and may reduce the postoperative complication rate and hospital stay after elective colorectal surgery.

A clinical pathway of multimodal rehabilitation in elective colorectal surgery was developed. After implementation, 90 consecutive patients received multimodal rehabilitation care from April to December 2006. Outcomes were compared with a control group of 134 patients receiving conventional care during 2005, just before the implementation of the new protocol. Demographics, surgical risk and type of surgery were similar in both groups.

With a clinical pathway of multimodal rehabilitation, on postoperative day 1 mobilization was accomplished in 68% of patients, early feeding in 52%, diet was well tolerated in 33% and intravenous fluids were stopped in 21% of patients. On postoperative day 5 predetermined discharge criteria were fulfilled in 82% of patients, although only 55% were discharged by postoperative day 6. Adherence to antibiotic prophylaxis protocol was better in the multimodal rehabilitation group (90% vs 41%; p < 0.001). Postoperative wound infection was lower in the multimodal rehabilitation group (13.3% vs 19.4%) with no statistical significance. Median hospital stay was significantly lower in the multimodal rehabilitation group (8.8 days vs 11.9 days; p = 0.03) with a mean of 6 days vs 9 days respectively.

A clinical pathway of multimodal rehabilitation in elective colorectal surgery reduces hospital stay without increasing morbidity rates.