'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery

Background: A combination of factors has emphasized the need to reduce post operative stay after surgery. Multimodal care plans may shorten hospital st ay, but have been associated with high readmission rates and are generally reserved for straightforward, non-complicated colonic (not rectal) resectio ns. This study evaluated a 'fast track' protocol in patients undergoing maj or colonic and rectal surgery. Methods: Sixty consecutive patients (median age 44.5 (range 13-70) years) u nderwent major procedures over a 6-week period on one colorectal service. N asogastric tubes and epidural anaesthesia were not used. Patients participa ted in a protocol of early diet and early ambulation, and were discharged a fter meeting defined criteria. Results: Fifty-eight patients (97 per cent) were deemed suitable for the 'f ast track' approach at the time of surgery and stayed for a mean(s.d.) of 4 .3(1.6) days after operation. Patients in diagnosis-related group (DRG) 148 (colorectal resection with co-morbidity; n=40) stayed for 4.6(1.7) days, w hich was longer than those in DRG 149 (without co-morbidity; n=18) who stay ed 3.5(0.8) days (P=0.01). Three patients (5 per cent) required a nasogastr ic tube for vomiting. There were no readmissions directly attributable to ' fast track' failure, although four patients (7 per cent) were readmitted wi thin 30 days of operation for other reasons. Eight poorly compliant patient s stayed for 5.1(1.1) days (P = 0.02 versus compliant patients). 'Fast trac k' patients had a shorter length of stay than patients receiving traditiona l care on other colorectal services during the same time period (compared b y DRG 148, DRG 149 and for all patients) (P<0.0001). Conclusion: The 'fast track' protocol allows patients with high levels of c o-morbidity undergoing complex colorectal and reoperative pelvic surgery to benefit from a rapid recovery and early discharge from hospital. The appro ach is safe and has low readmission rates.