[Can a fast-track protocol for elective colorectal resections be sustained in the clinical routine of German...

The structured implementation of fast-track or Enhanced recovery after surgery  protocols (ERAS) in elective colorectal resections is associated with benefits for patients in German hospitals; however, long-term experiences regarding continuous fast-track treatment in the routine clinical practice of German hospitals are not yet available. This manuscript summarizes the experiences of 11 hospitals with up to 4 years of fast-track application.

Analysis of prospectively collected data during and after the implementation of a structured fast-track program was performed. The study included all patients aged ≥ 18 years who were scheduled for elective colorectal resection and had given their consent. The outcome criteria were fast-track adherence, postoperative complications, functional recovery, postoperative length of hospital stay and the frequency of textbook-defined outcomes.

Among 1751 (48.3%) women and 1878 (51.8%) men with a median age of 68 years (interquartile range, IQR: 58-77 years), 2631 (72.5%) colon and 999 (27.5%) rectal resections were performed. Of the procedures 2973 (81.9%) were performed using minimally invasive techniques of which 670 (18.7%) were robotic and 657 (18.1%) were open procedures. Fast-track adherence was 82% (preoperative 89%, intraoperative 88% and postoperative 82%). The median postoperative length of stay was low at 5 (IQR: 4-8) days. Fast-track adherence increased from 79% during implementation to 86% after implementation (p < 0.0001). The postoperative length of stay decreased from 6 to 5 days (p < 0.0001). The postoperative complication rates were 35.5% during and 28.8%-29.7% after implementation (p = 0.003). While reoperations (8.6-9.7%) and inpatient readmissions (7.4-8.2%) did not differ, the achievement of textbook-defined outcomes significantly increased from 55.2% to 63.2% (p = 0.0005).

A structured fast-track program for elective colorectal resections continuously achieves good results in clinical practice, even several years after its implementation. Significant improvements were also achieved after the implementation phase had been completed.