Clin Colon Rectal Surg 2003; 16(2): 085-090
DOI: 10.1055/s-2003-40745
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

'Fast-Track' Postoperative Management Protocols for Colorectal Surgery

Anthony J. Senagore, Conor P. Delaney
  • Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
Further Information

Publication History

Publication Date:
18 July 2003 (online)

ABSTRACT

The traditional postoperative hospital stay after major gastrointestinal surgery has been lengthy. Advances in healthcare, increased understanding of postoperative physiology, financial pressure of healthcare payers, the impact of laparoscopic colectomy, and the increasing scarcity of ancillary healthcare personnel also have created a need to maximize the use of available hospital beds. These factors and the implementation of appropriately designed accelerated and standardized postoperative care pathways have demonstrated that open and laparoscopic colorectal surgery patients are indeed capable of shorter periods of ileus, an earlier tolerance of a general diet, and that early discharge may be accomplished safely for the patient, even after intestinal anastomosis.

REFERENCES

  • 1 Schoetz D JJ, Bockler M, Rosenblatt M S. et al . 'Ideal' length of stay after colectomy: whose ideal?.  Dis Colon Rectum . 1997;  40 806-810
  • 2 Bokey E L, Chapuis P H, Fung C. et al . Postoperative morbidity and mortality following resection of the colon and rectum for cancer.  Dis Colon Rectum . 1995;  38 480-487
  • 3 Retchin S M, Pinberthy L, Desch C. et al . Perioperative management of colonic cancer under Medicare risk programs.  Arch Int Med . 1997;  157 1878-1884
  • 4 Pearson S D, Goulart-Fisher D, Lee T H. Critical pathways as a strategy for improving patient care.  Ann Intern Med . 1995;  123 941-948
  • 5 Archer S B, Burnett R J, Flesch L V. et al . Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch/anal anastomosis.  Surgery . 1997;  122 699-705
  • 6 Bardram L, Funch-Jensen P, Jensen P. et al . Recovery after laparoscopic colonic surgery with epidural analgesia and early oral nutrition and mobilisation.  Lancet . 1995;  345 763-764
  • 7 Senagore A J, Luchtefeld M A, MacKeigan J. What is the learning curve for laparoscopic colectomy?.  Am Surg . 1995;  61 681-685
  • 8 Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation.  Br J Anaesth . 1997;  78 606-617
  • 9 Scott N B, James K, Murphy M, Kehlet H. Continuous thoracic epidural analgesia versus combined spinal/thoracic epidural analgesia on pain, pulmonary function and the metabolic response following colonic resection.  Acta Anaesthesiol Scand . 1996;  40 691-696
  • 10 Senagore A J, Duepree H J, Delaney C P, Brady K M, Fazio V W. Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30 month experience.  Dis Colon Rectum . 2003;  46 503-504
  • 11 Schwenk W, Bohm B, Haase O, Junghans T, Muller J M. Laparoscopic versus conventional colorectal resection: a prospective randomized study of postoperative ileus and early postoperative feeding.  Langenbecks Arch Surg . 1998;  383 49-55
  • 12 Senagore A J, Kilbride M J, Luchtefeld M A, MacKeigan J M, Davis A T, Moore J D. Superior nitrogen balance after laparoscopic-assisted colectomy.  Ann Surg . 1995;  221 171-175
  • 13 Binderow S R, Cohen S M, Wexner S D, Nogueras J J. Must early postoperative oral intake be limited to laparoscopy?.  Dis Colon Rectum . 1994;  37 584-589
  • 14 Di Fronzo A L, Cymerman J, O'Connell T X. Factors affecting early postoperative feeding following elective open colon resection.  Arch Surg . 1999;  134 941-946
  • 15 Behrns K E, Kircher A P, Galanko J A. et al . Prospective randomized trial of early initiation and hospital discharge on a liquid diet following elective intestinal surgery.  J Gastrointest Surg . 2000;  4 217-221
  • 16 Kehlet H, Mogensen T. Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme.  Br J Surg . 1999;  86 227-230
  • 17 Basse L, Jakobsen D H, Billesbolle P. et al . A clinical pathway to accelerate recovery after colonic resection.  Ann Surg . 2000;  232 51-57
  • 18 Reissman P, Teoh T-A, Cohen S M. et al . Is early feeding safe after elective colorectal surgery?.  <~>A prospective randomized trial. Ann Surg . 1995;  222 73-77
  • 19 Bradshaw B CG, Liu S S, Thirlby R C. Standardized perioperative care protocols and reduced length of stay after colon surgery.  J Am Coll Surg . 1998;  186 501-506
  • 20 Delaney C P, Fazio V W, Senagore A J, Robinson B, Halverson A L, Remzi F H. 'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery.  Br J Surg . 2001;  88 533-538
  • 21 Friedrich M, Rixecker D, Friedrich G: Evaluation of stress-related hormones after surgery. Clin Exp Obstet Gynecol .  1999;  26 71-75
  • 22 Koltun W A, Bloomer M M, Tilberg A F. et al . Awake epidural anesthesia is associated with improved natural killer cell cytotoxicity and a reduced stress response.  Am J Surg . 1996;  171 68-73
  • 23 Fellander G, Nordenstrom J, Tjader I, Bolinder J, Arner P. Lipolysis during abdominal surgery.  J Clin Endocrinol Metab . 1994;  78 150-155
  • 24 Steinbrook R A. Epidural anesthesia and gastrointestinal motility.  Anesth Analg . 1998;  86 837-844
  • 25 Audeau A, Newell P, Dobbs B R, Frizelle F A, Kennedy R. Postoperative epidural analgesia following elective major abdominal surgery in high risk patients: a retrospective cohort study.  N Z Med J . 2002;  115 69-72
  • 26 De Leon-Casasola A O, Parker B, Lema M J, Harrison P, Massey J. Postoperative epidural bupivacaine-morphine therapy.  Anesthesiology. 1994;  81 368-375
  • 27 Rodgers A, Walker N, Schug S. et al . Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials.  BMJ . 2000;  321 1493-1497
  • 28 Rigg J RA, Jamrozik K, Myles P S. et al . Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial.  Lancet . 2002;  359 1276-1282
  • 29 Liu S S, Carpenter R L, Mackey D C. et al . Effects of perioperative analgesic technique on rate of recovery after colon surgery.  Anesthesiology . 1995;  83 757-765
  • 30 Neudecker J, Schwenk W, Junghans T, Pietsch S, Bohm B, Muller JM: Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg .  1999;  86 1292-1295
  • 31 Senagore A J, Delaney C P, Fazio V W, Mekhail N. A prospective randomized controlled trial evaluating epidural anesthesia/analgesia in laparoscopic segmental colectomy (in press).  Br J Surg.
  • 32 Filos K S, Lehman K A. Current concepts and practices in postoperative pain management: need for change?.  Eur Surg Res . 1999;  31 97-101
  • 33 Warfield C A, Kahn C H. Acute pain management: programs in US hospitals and experiences and attitudes among US adults.  Anesthesiology . 1995;  83 1090-1094
  • 34 Kiran R P, Delaney C P, Senagore A J, Steel M, Fazio V W. Prediction of readmission after intestinal resection (submitted).  Ann Surg.
  • 35 Hardwick R H, Saltrese-Taylor A, Collins C D. Need to measure outcome after discharge in surgical unit.  Qual Health Care . 1992;  1 165-167
  • 36 Azimuddin K, Rosen L, Reed III F J, Stasik J J, Riether R D, Khubchandani I T. Readmissions after colorectal surgery cannot be predicted.  Dis Colon Rectum . 2001;  44 942-946
    >