Match!

CONVALESCENCE AFTER COLONIC RESECTION WITH FAST-TRACK VERSUS CONVENTIONAL CARE

Published on Mar 1, 2004in Scandinavian Journal of Surgery1.533
· DOI :10.1177/145749690409300105
D. Hjort Jakobsen1
Estimated H-index: 1
(UCPH: University of Copenhagen),
E. Sonne3
Estimated H-index: 3
+ 2 AuthorsHenrik Kehlet107
Estimated H-index: 107
(UCPH: University of Copenhagen)
Abstract
Background: Multi-modal rehabilitation programmes may improve early postoperative body composition, pulmonary function, exercise capacity, and reduce hospital stay. So far, no data are available on convalescence after discharge. Aim: The objectives where to compare convalescence data (fatigue, sleep, time to resume normal activities, and functional capabilities) and need for nursing care and contact to general practitioner with fast-track multi-modal rehabilitation compared with conventional care after colonic surgery. Methods: Non-randomised, prospective controlled study in 30 consecutive patients undergoing fast-track rehabilitation with continuous epidural analgesia, enforced oral nutrition, mobilisation, planned early discharge, and 30 consecutive patients undergoing conventional care. Patients were interviewed preoperatively and 14 and 30 days postoperatively. Results: Median hospital stay was 2 vs. 8 days in the fast-track vs. conventional care group, respectively (p <0 .01). Fourteen days postoperatively, total and mid-day sleep were increased in the conventional care group when compared with the fast-track group (p <0 .01). Fatigue was increased significantly at 14 days (p <0 .05) and throughout the study period compared with the fast-track group (p <0 .01). Similarly, ability to walking stairs, cooking, house keeping, shopping and walking outdoor was significantly less reduced at 14 days in the fast-track group, who also regained leisure activities earlier (p <0 .05). There was no significant difference between groups at 30 days or between need for nursing care and visits to general practitioners. Readmission for surgery-related events occurred more frequently (5 vs 1 patient) in the fast-track group. Conclusion: Fast-track rehabilitation with early discharge after colonic surgery results in earlier resumption of normal activities with reduced fatigue and need for sleep postoperatively compared to conventional care, and without increased need for nursing care or visits to general practitioners. However, readmissions may occur more frequently.
  • References (10)
  • Citations (70)
📖 Papers frequently viewed together
346 Citations
399 Citations
309 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References10
Newest
#1Henrik KehletH-Index: 107
#2Douglas W. Wilmore (Brigham and Women's Hospital)H-Index: 73
Abstract Objective: To evaluate the effect of modifying perioperative care in noncardiac surgical patients on morbidity, mortality, and other outcome measures. Background: New approaches in pain control, introduction of techniques that reduce the perioperative stress response, and the more frequent use of minimal invasive surgical access have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated. Methods: W...
1,116 CitationsSource
#1Linda Basse (Copenhagen University Hospital)H-Index: 11
#2H. H. Raskov (Copenhagen University Hospital)H-Index: 1
Last. Henrik Kehlet (Copenhagen University Hospital)H-Index: 107
view all 8 authors...
309 CitationsSource
#1M. G. Henriksen (Aarhus University Hospital)H-Index: 4
#2Henriette V. Hansen (Aarhus University Hospital)H-Index: 1
Last. Ib Hessov (Aarhus University Hospital)H-Index: 14
view all 3 authors...
Abstract Early postoperative nutrition reduces morbidity. We investigated whether the introduction of a new postoperative analgesic and ambulation regimen with enforced mobilization from postoperative day 1 would influence postoperative nutrition intake. Nutrition intake was recorded daily by a record method and compared with the intake in a control group that received the same nutrition regimen but a traditional analgesic and ambulation regimen. The mean intakes of energy during postoperative d...
64 CitationsSource
#1M. G. Henriksen (Aarhus University Hospital)H-Index: 4
#2Martin Bach Jensen (Aarhus University Hospital)H-Index: 19
Last. Ib Hessov (Aarhus University Hospital)H-Index: 14
view all 5 authors...
Abstract OBJECTIVE: A postoperative regimen using a multimodal approach with enforced mobilization and early oral nutrition has been reported to improve convalescence but has not been compared with other postoperative regimens. METHODS: Forty patients undergoing elective colorectal surgery were randomly allocated to an intervention group receiving comprehensive information on the importance of mobilization, balanced anesthesia, and postoperative analgesia including epidural local anesthetics and...
97 CitationsSource
#1Conor P. Delaney (Cleveland Clinic)H-Index: 62
#2Victor W. Fazio Mb (Cleveland Clinic)H-Index: 98
Last. Feza H. Remzi (Cleveland Clinic)H-Index: 63
view all 6 authors...
Background: A combination of factors has emphasized the need to reduce postoperative stay after surgery. Multimodal care plans may shorten hospital stay, but have been associated with high readmission rates and are generally reserved for straightforward, non-complicated colonic (not rectal) resections. This study evaluated a ‘fast track’ protocol in patients undergoing major colonic and rectal surgery. Methods: Sixty consecutive patients (median age 44·5 (range 13–70) years) underwent major proc...
302 CitationsSource
#1Anthony J. Senagore (Cleveland Clinic)H-Index: 57
#2David G. Whalley (Cleveland Clinic)H-Index: 9
Last. Victor W. Fazio Mb (Cleveland Clinic)H-Index: 98
view all 6 authors...
Abstract Background. Aggressive postoperative care plans after open colectomy may allow earlier discharge, especially in conjunction with preoperative thoracic epidural anesthesia-analgesia using a local anesthetic and narcotic. The purpose of this study was to evaluate the role of thoracic epidural anesthesia-analgesia using bupivacaine and fentanyl citrate in reducing lengths of stay after laparoscopic colectomy (LAC). Methods. A consecutive cohort of patients who underwent LAC and who receive...
67 CitationsSource
#1Linda BasseH-Index: 11
Last. Henrik KehletH-Index: 107
view all 6 authors...
12 Citations
#1Linda BardramH-Index: 24
#2Peter Funch-JensenH-Index: 33
Last. Henrik KehletH-Index: 107
view all 3 authors...
Background Introduction of the laparoscopic surgical technique has reduced hospital stay after colonic resection from about 8–10 to 4–6 days. In most studies, however, specific attention has not been paid to changes in perioperative protocols required to maximize the advantages of the minimally invasive procedure. In the present study the laparoscopic approach was combined with a perioperative multimodal rehabilitation protocol. Methods After laparoscopically assisted colonic resection, patients...
155 CitationsSource
#1Linda BasseH-Index: 11
Last. Henrik KehletH-Index: 107
view all 5 authors...
624 CitationsSource
#1T. ChristensenH-Index: 1
#2T. BendixH-Index: 1
Last. H. KehletH-Index: 1
view all 3 authors...
Subjective feelings of fatigue were assessed before operation and 10, 20 and 30 days after uncomplicated elective abdominal surgery in 16 otherwise healthy patients, using a constructed fatigue scale model. In addition, all patients had an orthostatic stress test performed at the same times. Six of the patients also underwent a bicycle ergometer test measuring heart rate and oxygen consumption. Subjective feelings of fatigue were increased (P<0.01) at all three postoperative observations, and on...
173 CitationsSource
Cited By70
Newest
#1Michael Nunns (University of Exeter)H-Index: 5
#2Liz Shaw (University of Exeter)H-Index: 2
Last. Robert Anderson (University of Exeter)H-Index: 65
view all 9 authors...
1 CitationsSource
#1Meara Dean (Cambridge University Hospitals NHS Foundation Trust)
#2R. Justin Davies (Cambridge University Hospitals NHS Foundation Trust)H-Index: 7
Enhanced recovery after surgery (ERAS) programmemes are evidence-based multimodality protocols designed to optimise perioperative care. Although the individual components may vary, the overall aim is to reduce surgical trauma and perioperative surgery stress through pre-, intra- and postoperative interventions. These protocols have been shown to be effective in reducing overall postoperative complications and length of hospital stay without compromising patient safety.
Source
#1Nessn H. Azawi (UCPH: University of Copenhagen)H-Index: 4
#2Tom ChristensenH-Index: 4
Last. Lars Lund (OUH: Odense University Hospital)H-Index: 31
view all 4 authors...
Purpose of Review The purposes of this review were to identify the possible limiting factors prohibiting laparoscopic nephrectomy being performed as an outpatient surgery and optimize these limiting factors.
1 CitationsSource
#1Scott E. Regenbogen (UM: University of Michigan)H-Index: 27
#2Anne H. Cain-Nielsen (UM: University of Michigan)H-Index: 6
Last. Jonathan S. Skinner (Dartmouth College)H-Index: 66
view all 6 authors...
Importance As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. Objective To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use an...
28 CitationsSource
#1Scott E. Regenbogen (UM: University of Michigan)H-Index: 27
#2Nirav J. Shah (UM: University of Michigan)H-Index: 1
Last. D. A. CambellH-Index: 50
view all 6 authors...
8 CitationsSource
#1Christian JurowichH-Index: 15
#2C.-T. GermerH-Index: 26
Die laparoskopische Hemikolektomie links fur linksseitige Kolonkarzinome gehort heute zu den laparoskopischen Standardeingriffen in erfahrenen minimalinvasiven Operationszentren. Die Herausforderung besteht darin, die bekannten onkologischen Standards aus der offenen Chirurgie auch minimalinvasiv umzusetzen. Das nachfolgende Kapitel stellt hierfur die Details der Operationstechnik und die operativen Teilschritte sorgfaltig vor.
Source
#1Zhen Fan (Memorial Hermann Memorial City Medical Center)H-Index: 2
#2Conor P. Delaney (Cleveland Clinic)H-Index: 62
Colorectal carcinoma is a very common malignancy in most western countries. Based on data from National Cancer Institute in 2008, it is estimated that 148,810 new cases would be diagnosed (108,070 colon, 40,740 rectal) in the United States The combined mortality is estimated to be 49,960, making colorectal carcinoma the second most common cause of combined male and female mortality after lung cancer and the most common solid tumor after skin malignancies.
Source
Source
#1Jeanny J. A. de Groot (UM: Maastricht University)H-Index: 3
#2José M. C. Maessen (UM: Maastricht University)H-Index: 5
Last. Trudy van der Weijden (UM: Maastricht University)H-Index: 41
view all 6 authors...
Background Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands. The trial will evaluate effectiveness and costs of a stepped implementation approach that is characterised by tailoring the intensity of implementation activities to the nee...
6 CitationsSource
#1Jitesh B. Shewale (University of Texas MD Anderson Cancer Center)H-Index: 3
#2Arlene M CorreaH-Index: 42
Last. Stephen G. SwisherH-Index: 48
view all 13 authors...
Objective To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS) and hospital charges.
35 CitationsSource