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CONVALESCENCE AFTER COLONIC RESECTION WITH FAST-TRACK VERSUS CONVENTIONAL CARE

Published on Mar 1, 2004in Scandinavian Journal of Surgery1.53
· DOI :10.1177/145749690409300105
D. Hjort Jakobsen1
Estimated H-index: 1
(UCPH: University of Copenhagen),
E. Sonne3
Estimated H-index: 3
+ 2 AuthorsHenrik Kehlet105
Estimated H-index: 105
(UCPH: University of Copenhagen)
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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 (67)
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References10
Newest
Published on Jun 1, 2002in American Journal of Surgery2.20
Henrik Kehlet105
Estimated H-index: 105
,
Douglas W. Wilmore72
Estimated H-index: 72
(Brigham and Women's Hospital)
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...
Published on Apr 1, 2002in British Journal of Surgery5.59
Linda Basse11
Estimated H-index: 11
(Copenhagen University Hospital),
H. H. Raskov1
Estimated H-index: 1
(Copenhagen University Hospital)
+ 5 AuthorsHenrik Kehlet105
Estimated H-index: 105
(Copenhagen University Hospital)
Background: Postoperative organ dysfunction contributes to morbidity, hospital stay and convalescence. Multimodal rehabilitation with epidural analgesia, early oral feeding, mobilization and laxative use after colonic resection has reduced ileus and hospital stay. Methods: Fourteen patients receiving conventional care (group 1) and 14 patients who had multimodal rehabilitation (group 2) were studied before and 8 days after colonic resection. Outcome measures included postoperative mobilization, ...
Published on Mar 1, 2002in Nutrition3.59
M. G. Henriksen4
Estimated H-index: 4
(Aarhus University Hospital),
Henriette V. Hansen1
Estimated H-index: 1
(Aarhus University Hospital),
Ib Hessov12
Estimated H-index: 12
(Aarhus University Hospital)
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...
Published on Feb 1, 2002in Nutrition3.59
M. G. Henriksen4
Estimated H-index: 4
(Aarhus University Hospital),
Martin Bach Jensen19
Estimated H-index: 19
(Aarhus University Hospital)
+ 2 AuthorsIb Hessov12
Estimated H-index: 12
(Aarhus University Hospital)
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...
Published on Nov 1, 2001in British Journal of Surgery5.59
Conor P. Delaney59
Estimated H-index: 59
(Cleveland Clinic),
Victor W. Fazio Mb95
Estimated H-index: 95
(Cleveland Clinic)
+ 3 AuthorsFeza H. Remzi60
Estimated H-index: 60
(Cleveland Clinic)
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...
Published on Jun 1, 2001in Surgery3.48
Anthony J. Senagore55
Estimated H-index: 55
(Cleveland Clinic),
David G. Whalley13
Estimated H-index: 13
(Cleveland Clinic)
+ 3 AuthorsVictor W. Fazio Mb95
Estimated H-index: 95
(Cleveland Clinic)
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...
Published on Feb 12, 2001in Ugeskrift for Læger
Linda Basse11
Estimated H-index: 11
,
Dorthe Hjort Jakobsen6
Estimated H-index: 6
+ 3 AuthorsHenrik Kehlet105
Estimated H-index: 105
Published on Nov 1, 2000in British Journal of Surgery5.59
Linda Bardram24
Estimated H-index: 24
,
Peter Funch-Jensen40
Estimated H-index: 40
,
Henrik Kehlet105
Estimated H-index: 105
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...
Published on Jul 1, 2000in Annals of Surgery9.48
Linda Basse11
Estimated H-index: 11
,
Dorthe Hjort Jakobsen6
Estimated H-index: 6
+ 2 AuthorsHenrik Kehlet105
Estimated H-index: 105
The postoperative hospital stay after colonic resection is usually 6 to 12 days, 1–6 with a complication rate of 10% to 20%, because many patients are elderly and at high risk. The recent introduction of multimodal postoperative rehabilitation regimens including epidural analgesia, early enteral nutrition, and early mobilization and revision of the surgical care program have reduced the hospital stay to approximately 5 days. 7–9 The introduction of laparoscopic-assisted colonic surgery has also ...
Published on Jul 1, 1982in British Journal of Surgery5.59
T. Christensen1
Estimated H-index: 1
,
T. Bendix1
Estimated H-index: 1
,
H. Kehlet1
Estimated H-index: 1
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...
Cited By67
Newest
Published on Jan 1, 2019
Meara Dean , R. Justin Davies6
Estimated H-index: 6
(Cambridge University Hospitals NHS Foundation Trust),
R. Justin Davies
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.
Published on Jan 1, 2018in Current Urology Reports2.08
Nessn H. Azawi4
Estimated H-index: 4
(UCPH: University of Copenhagen),
Tom Christensen3
Estimated H-index: 3
+ 1 AuthorsLars Lund27
Estimated H-index: 27
(OUH: Odense University Hospital)
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.
Published on May 17, 2017in JAMA Surgery10.67
Scott E. Regenbogen26
Estimated H-index: 26
(UM: University of Michigan),
Anne H. Cain-Nielsen5
Estimated H-index: 5
(UM: University of Michigan)
+ 3 AuthorsJonathan S. Skinner65
Estimated H-index: 65
(Dartmouth College)
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...
Published on May 1, 2017in Annals of Surgery9.48
Scott E. Regenbogen26
Estimated H-index: 26
(UM: University of Michigan),
Nirav J. Shah1
Estimated H-index: 1
(UM: University of Michigan)
+ 3 AuthorsD. A. Cambell49
Estimated H-index: 49
Published on Jan 1, 2017
Christian Jurowich16
Estimated H-index: 16
,
C.-T. Germer23
Estimated H-index: 23
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.
Published on Jan 1, 2017
Zhen Fan2
Estimated H-index: 2
(Memorial Hermann Memorial City Medical Center),
Conor P. Delaney59
Estimated H-index: 59
(Cleveland Clinic)
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.
Published on Dec 1, 2015in Implementation Science4.53
Jeanny J.A. de Groot3
Estimated H-index: 3
(UM: Maastricht University),
José M.C. Maessen5
Estimated H-index: 5
(UM: Maastricht University)
+ 3 AuthorsTrudy van der Weijden38
Estimated H-index: 38
(UM: Maastricht University)
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...
Published on Jun 1, 2015in Annals of Surgery9.48
Jitesh B. Shewale3
Estimated H-index: 3
(University of Texas MD Anderson Cancer Center),
Arlene M Correa41
Estimated H-index: 41
+ 10 AuthorsBarbara L. Summers5
Estimated H-index: 5
(University of Texas MD Anderson Cancer Center)
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.
View next paperProspective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection.