Clinical evaluation of fast track protocol versus standard care in patients undergoing elective colorectal surgeries
DOI:
https://doi.org/10.18203/2349-2902.isj20163486Keywords:
Fast track, Eras protocol, Colorectal surgeriesAbstract
Background: Colo rectal surgeries are on the rise given colorectal carcinoma being the third most common cancer globally affecting more than 1 million people every year. Apart from carcinoma colo rectal surgeries are performed for severe inflammatory bowel diseases, strictures, diverticular diseases etc. The traditional approach to colo rectal surgery has been associated with high morbidity subjecting the patient to unnecessary preparations and prolonged hospital stay. Fast-track surgery consists of a protocol of evidence-based techniques to reduce surgical trauma and postoperative stress by minimizing pain, reducing complications, improving outcomes, and decreasing length of hospital stay while expediting recovery following elective procedures. Fast track protocols for colorectal surgery patients were developed to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery.
Methods: A total of 40 patients who are undergoing any elective colo-rectal surgeries will be included in the prospective study. Details regarding the age, sex and diagnosis were collected. Operative parameters and post-operative complications were recorded. Post-operative course in hospital and any deviation of normal post-operative course and its management is recorded and analyzed.
Results: The overall complication rates were significantly higher in the control group as compared to the Fast track group (p<0.05). The duration of stay was found to be significantly shorter in the study group (mean 8.8 days Vs 11.7 days).
Conclusions: This evaluation provides strong evidence that the fast track approach is safe in colo-rectal surgeries and is not associated with increased incidence of complications. It results in significantly reduced duration of hospitalisation and reduction in overall cardio-pulmonary morbidity and complications.References
Egbert LG, Bant GE, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patient. N Engl J Med. 1964;207:824-7.
Kieholt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery. Am Psychol. 1998;53:1209-18.
Wilmore D. From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg. 2002;236(5):643-8.
Palmer JF. Complete Works of John Hunter. Philadelphia: Haswell, Barrington, Haswell, 1935:622.
Kussmaul CA. Heilung von Ileus durch Magenausspulung. Berl Klin Wschr. 1884;21:669-85.
Levin AI. A new gastroduodenal catheter. JAMA. 1921;76:1007-9.
Wangensteen OH. The early diagnosis of acute intestinal obstruction with comments on pathology and treatment: with a report of successful decompression of three cases of mechanical bowel obstruction by nasal catheter suction siphonage. West J Surg Obstet Gynaecol. 1932;40:1-17.
Gerber A, Rogers FA, Smith LL. The treatment of paralytic ileus without the use of gastrointestinal suction. Surg Gynaecol Obstet. 1958;107:247-50.
Gerber A. an appraisal of paralytic ileus and the necessity of postoperative gastrointestinal suction. Surg Gynaecol Obstet. 1963;117:294.
Shibata Y, Toyoda S, Nimura Y, Miyati M. Patterns of intestinal motility recovery during the early stage following abdominal surgery: Clinical and manometric study. World J Surg 1997; 21: 806-810.
McIver MA, Benedict EB, Cline JW. Postoperative gaseous distension of the abdomen. Arch Surg. 1926;155:1197-9.
