[Fast track rehabilitation in visceral surgery]

Abstract

In general and visceral surgery fast-track rehabilitation means a procedure-specific, evidence-based, multimodal, interdisciplinary and patient-focussed clinical pathway in perioperative therapy. The primary goals of fast-track rehabilitation are to maintain patient autonomy and homeostasis, minimization of postoperative organ dysfunction and prevention of postoperative general morbidity (i.e. cardiopulmonary complications, nosocomial infections). At the same time, postoperative recovery is accelerated and early discharge from hospital after surgery becomes possible. Fast-track-pathways are now available for all common procedures in general and visceral surgery, 14 years after the first publication of a clinical fast-track pathway for patients undergoing elective colon resection by the Danish surgeon Henrik Kehlet and his co-workers. The main principles of fast-track rehabilitation are patient information and education, evidence-based preoperative preparation and risk minimization, modern anesthesia and analgesia, avoidance of drains and catheters, early postoperative oral or enteral feeding and forced mobilization. Introduction of clinical fast-track pathways will lead to profound changes from traditional to evidence-based behavior of physicians and nursing personnel. Therefore, implementation of fast-track programs should be accompanied by intensive education and collaboration of all professional groups concerned with perioperative patient care. So far, visceral surgeons have been leading the field of fast-track rehabilitation and fast-track could be a way for surgeons to recapture lost ground in perioperative medicine. Therefore, intensive experimental and clinical research in fast-track rehabilitation is strongly recommended for visceral surgeons to maintain competence in scientific discussions with other medical specialists.