Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme

Background: Hospital stay after colonic surgery is usually between 5 and 10 days, limiting factors being pain, ileus, organ dysfunction and fatigue. S ingle-modality intervention to reduce these factors with laparoscopic surge ry usually requires a hospital stay of 5 days. This paper reports the resul ts of a multimodal rehabilitation regimen after open sigmoidectomy. Methods: Sixteen unselected patients scheduled for elective sigmoid resecti on (median age 71 years) underwent operation under combined spinal-epidural anaesthesia. After operation, epidural analgesia was continued for 48 h, w ith immediate oral nutrition and mobilization, and with planned discharge 2 days after surgery. Results: The median postoperative hospital stay was 2 (range 2-6) days (48 h), patients being mobilized for a median of 5 h on the second postoperativ e day (24-48 h) and for 10 h on the third day (48-72 h). Within 48 h of ope ration 14 patients had an oral intake of 2000 ml or more and 15 had resumed defaecation. Fatigue and pain scores were low during the first 8-9 days af ter operation, with a median of 13 h of mobilization per day after discharg e. There were no medical or surgical complications during 30 days of follow -up, except for two patients who suffered postspinal headache. Conclusion: Postoperative recovery after open colonic surgery may be accele rated by effective pain relief integrated into an accelerated rehabilitatio n programme.