Colonic surgery with accelerated rehabilitation or conventional care

Abstract

Background: For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome after colonic resection with conventional care compared with fast-track multimodal rehabilitation.

Methods: One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2) in another hospital. Outcomes were time to first defecation after surgery, postoperative hospital stay, and morbidity during the first postoperative month.

Results: Median age was 74 years (group 1) and 72 years (group 2). American Society of Anesthesiologists (ASA) score was significantly higher in group 2 ( P < 0.05). Defecation occurred on day 4.5 in group 1 and day 2 in group 2 ( P < 0.05). Median hospital stay was 8 days in group 1 and 2 days in group 2 ( P < 0.05). The use of a nasogastric tube was longer in group 1 ( P < 0.05). The overall complication rate (35 patients) was lower in group 2 ( P < 0.05), especially cardiopulmonary complications (5 patients; P < 0.01). Readmission was necessary in 12 percent of cases for group 1 and 20 percent in group 2 ( P > 0.05).

Conclusions: Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast-track multimodal rehabilitation.