Insights into fast-track in colorectal surgery: a plea for tailoredprogram: OP29


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Abstract

Aim:To compare the results of Fast-Track (FT)program to a retrospective control (CONT) group treated with conventional peri-operative care. The endpoint was to assess the optimal reduction in length of hospital stay (LOS) without increasing post-operative complications.Method:Two hundred and forty-three consecutive patients undergoing colorectal surgery were included in the study: 124 in FT group and 119 in CONT group. Exclusion criteria were:primary rectal disease, derivative stoma, ASA score and AFC index > 3. A multivariate logistic regression analysis was performed to select variables influencing LOS.Results:Mortality rate was 0% in FT group and 0.8% in CONT group (P = n.s.). The overall complication rate was 30.6% and 38.6% in FT and CONT groups (P = n.s.). The median LOS was significantly reduced [3 (2,16) vs 6 (3,29) days] in FT patients (P < 0.001). The emergency readmission rate was 16.9% and 7.6% in FT and CONT groups respectively (P = 0.026) and rehospitalisation rate 8% vs 4.2% (P = n.s.). Independent risk factors for increased LOS were age > 69 years (P = 0.001), laparotomy (P = 0.011) and conventional peri-operative care (P < 0.001).Conclusion:Fast-trackprogram reduces the LOS without increasing the complication rate but should be tailored according to patient's age and surgical approach.

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