[Tolerance of accelerated postoperative rehabilitation following intestinal resections]

Modern procedures in peri-operative care arising from evidence-based medicine improve postoperative results. Their acceptance is however not a common clinical practice at most surgical centers.

The aim of our study was to design a protocol and introduce it into the praxis. The subject of announcement is tolerance of protocol in our conditions.

Prospective randomized study included patients who were operated on (open bowel resection) at Department of Surgery in period 4/2005-12/2007. They were randomized in fast track group (n=53) and non-fast track group (n=52). Protocol with accelerated recovery was used in the fast track group (FTG) and we used traditional approach in the not-fast track (non-FTG). Results were statistically evaluated, 2 patients (FTG) were excluded from analysis for protocol failure (protocol was non kept by anesthesiologist in 1 patient and by the nurse in the second patient). Protocol and informed consent form was approved by the Hospital Ethics Committee.

Both groups did not differ in age, diagnosis and length of surgery. Analgesia was controlled significantly better in FTG; similarly oral intake tolerance was higher in this group (day of surgery--mean value 634 ml versus 304 ml). Restoration of bowel functions was also faster in interventional group (mean time 2.1 versus 3.9 days). Frequency of postoperative complications was lower and hospital stay was shorter (median 7.0 versus 9.0 days, p < 0.001).

Designed fast track protocol of postoperative recovery could be introduced in clinical praxis in terms of study. Patients' tolerance was very good. Application of accelerated recovery procedures is possible in our conditions but it means primarily to overcome worse tolerance of attending personnel.