Good compliance to enhanced recovery program improves outcome after colorectal surgery

The fast-track (FT) protocol consists of several measures to optimize physiologic response to the surgical stress and improve postoperative outcome. Our goal was to evaluate the compliance to our protocol and to analyze the effect of compliance to the FT protocol on postoperative outcome and postoperative hospital stay. We also aimed to identify isolated FT measures able to influence outcome.

This retrospective study involves a cohort of consecutive patients who underwent colorectal surgery within a FT protocol between 2007 and 2013. Beside basic demographics, adherence to protocol, postoperative complications, and postoperative hospital stay (POHS) were recorded. Both univariate and multivariate analyses were performed to determine the predictive value of the FT protocol compliance and of specific FT items on surgical outcome and POHS.

There were 284 patients with a mean age of 58 years. Compliance to the FT protocol reached a median of 18 out of 19 items. The median hospital stay was 3 days (2-49). Overall complications rate was 34.9% and 7,4% when Dindo-Clavien classification > 2 was considered. Higher compliance to the FT protocol reduces the complication rate (p = 0.00004), severity of complication (p = 0.002), and POHS (p =  < 0.00001). We have not been able to identify any specific isolated FT measure able to influence post-operative outcome.

Greater adherence to the FT protocol decreases postoperative complications and POHS. Our data support a holistic effect of the FT protocol rather than specific isolated measures to improve the patient's postoperative outcome.