The Fast Track Concept in Colo-rectal Surgery A. Tuchmann, P. Razek, C. Kienbacher, P. Patri, K. Pinnisch, Hospital Floridsdorf, Vienna, Austria SMZ Floridsdorf, Vienna, Austria

What is Fast Track Surgery? synonyms : - accelerated recovery program - ERAS: enhanced recovery after surgery Prof Henrik Khelet, Kopenhagen, DK; 1989 Definition : a concept for acceleration of postoperative convalescence by a multimodal rehabilitation program

accelerated convalescence reduction of overall complications shorter hospital stay increased patient comfort optimal pain relief (EDC) perioperative fluid restriction early enteral nutrition early postoperative mobilization minimal use of tubes, drains, and catheters reduce: stress response organ dysfunction Modified W. Schwenk und J.M. Müller: Was ist "Fast-track"-Chirurgie? Deutsche Medizinische Wochenschrift 2005; 130 (10):

Pre- and perioperative period oral and written information about the surgery and postoperative procedure by attending surgeon in our outpatient clinic information about epidural catheter (EDC) and epidural analgesia by anaesthesiologist admission one day prior to surgery preoperative oral bowel preparation (Macrogol 3350), oral intake of clear fluids until 2 hours preoperative EDC placement in operating theatre postoperative mobilization ~ 5 hrs. after surgery free oral intake of fluids; yogurt or 2 protein drinks opioids and local anaesthetics through EDC

Postoperative period day 1: continuous pain management per EDC removal of urinary bladder catheter mobilization 8 hrs mashed food metamizole or paracetamole to relieve pain day 2: normal oral intake full mobilization removal of EDC NSAIDs orally on demand day 3-5: planned discharge day 8: checkup in the outpatient clinic, information on histological findings

Patient data ASA-criteria

Diagnoses conv.carefast-track

Operation technique conv.carefast-track

Results postop. stay 7 66%

Major complications

Treatment of major complications

Minor complications

Readmissions (Fast-Track)

Mortality

A view at surgical tradition and suspected disadvantages no bowel cleansing……………..anastomotic failure early oral feeding………………..vomiting / aspiration / pneumonia anastomotic failure no drainage……………………….retention, insufficiency no parenteral fluids………………thrombosis, renal failure enforced mobilization……………fatigue, exhaustion

Fast track and open surgery: complications total open surgeries: n = 16 total complications: n = 4

Summary I The fast track concept is 1. feasible at - Hospital Floridsdorf (hospital of the community of Vienna) - with non selected patients undergoing - colorectal surgery (open / lap.) 2. advantages: - reduction of general complications - accelerated convalescence - shorter hospital stay - patient satisfaction

Summary II 3. unchanged: - local complications 4. caution: - readmissions 5. question and hope: - reduction of costs - less immunosuppression - better oncologic results SMZ Floridsdorf, Vienna, Austria