Tolerance of Accelerated Postoperative Rehabilitation Following Intestinal Resections
Authors:
Z. Šerclová 1,3; P. Dytrych 1
; J. Marvan 1; K. Nová 4; Z. Hankeová 4; O. Ryska 1; Z. Šlégrová 5; L. Burešová 5; L. Trávníková 1; F. Antoš 2,3
Authors place of work:
Chirurgická klinika, Fakultní nemocnice Na Bulovce, Praha
1; Institut postgraduálního vzdělávání, Praha
2; 1. lékařská fakulta, Univerzita Karlova, Praha
3; Anesteziologické oddělení, Fakultní nemocnice Na Bulovce, Praha
4; Institut biostatistiky a analýzy, Masarykova univerzitní nemocnice, Brno
5
Published in the journal:
Rozhl. Chir., 2009, roč. 88, č. 4, s. 178-184.
Category:
Monothematic special - Original
Summary
Introduction:
Modern procedures in peri-operative care arising from evidence-based medicine improve postoperative results. Their acceptance is however not a common clinical practice at most surgical centers.
Aim:
The aim of our study was to design a protocol and introduce it into the praxis. The subject of announcement is tolerance of protocol in our conditions.
Patients and method:
Prospective randomized study included patients who were operated on (open bowel resection) at Department of Surgery in period 4/2005–12/2007. They were randomized in fast track group (n = 53) and non-fast track group (n = 52). Protocol with accelerated recovery was used in the fast track group (FTG) and we used traditional approach in the not-fast track (non-FTG). Results were statistically evaluated, 2 patients (FTG) were excluded from analysis for protocol failure (protocol was non kept by anesthesiologist in 1 patient and by the nurse in the second patient). Protocol and informed consent form was approved by the Hospital Ethics Committee.
Results:
Both groups did not differ in age, diagnosis and length of surgery. Analgesia was controlled significantly better in FTG; similarly oral intake tolerance was higher in this group (day of surgery – mean value 634 ml versus 304 ml). Restoration of bowel functions was also faster in interventional group (mean time 2.1 versus 3.9 days). Frequency of postoperative complications was lower and hospital stay was shorter (median 7.0 versus 9.0 days, p < 0.001).
Conclusion:
Designed fast track protocol of postoperative recovery could be introduced in clinical praxis in terms of study. Patients’ tolerance was very good. Application of accelerated recovery procedures is possible in our conditions but it means primarily to overcome worse tolerance of attending personnel.
Study was supported by grant:
IGA MZ ČR NR84-20-3.
Key words:
fast track – open bowel surgery – tolerance
Zdroje
1. Kehlet, H. Fast-track colonic surgery: status and perspectives. Recent Results Cancer Res., 2005; 165: 8–13. Review.
2. Soop, M., Nygren, J., Ljungqvist, O. Optimizing perioperative management of patients undergoing colorectal surgery: what is new? Curr. Opin. Crit. Care, 2006; Apr; 12(2): 166–170. Review.
3. Schwenk, W., Neudecker, J., Raue, W., et al. „Fast-track“ rehabilitation after rectal cancer resection. Int. J. Colorectal. Dis., 2006, Sep; 21(6): 547–553.
4. Kariv, Y., Delaney, C. P., Senagore, A. J., at al. Clinical outcomes and cost analysis of a „fast track“ postoperative care pathway for ileal pouch-anal anastomosis: a case control study. Dis. Colon Rectum, 2007, Feb; 50(2): 137–146.
5. Scharfenberg, M., Raue, W., Junghans, T., at al. „Fast-track“ rehabilitation after colonic surgery in elderly patients – is it feasible? Int. J. Colorectal Dis., 2007, Dec; 22(12): 1469–1474.
6. Zutshi, M., Delaney, C. P., Senagore, A. J., at al. Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia afiter laparotomy and intestinal resection. Am. J. Surg., 2005, Mar; 189(3): 268–272.
7. Fearon, K. C., Ljungqvist, O., von Meyenfeldt, M., et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin. Nutr., 2005, Jun; 24(3): 466–477.
8. Khoo, C. K., Vickery, C. J., Forsyth, N., et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann. Surg., 2007, Jun; 245(6): 867–872.
9. Lassen, K., Dejong, C. H., Ljungqvist, O., et al. Nutritional support and oral intake after gastric resection in five northern European countries. Dig. Surg., 2005; 22(5): 346–352; discussion 352. 2005; 22(5): 346–352; discussion 352.
10. Hausel, J., Nygren, J., Lagerkranser, M. et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth. Analg., 2001, Nov; 93(5): 1344–1350.
11. Weimann, A., Braga, M., Harsanyi, L., et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Surgery including organ transplantation. Clin. Nutr., 2006, Apr; 25(2): 224–244.
12. Liu, S. S., Wu, C. L. Effect of postoperative analgesia on major postoperative complications: and systematic update of the evidence. Anesth. Analg., 2007, Mar; 104(3): 689–702.
13. Carli, F., Mayo, N., Klubien, K., et al. Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial. Anestesiology, 2002, Sep; 97(3): 540–549.
14. Clemente, A., Carli, F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiologica, 2008, Oct; 74(10): 549–563.
15. Low, J., Johnston, N., Morris, C. Epidural analgesia: first do no harm. Anaesthesia, 2008, Jan; 63(1): 1–3. Erratum in: Anaesthesia, 2008, Oct; 63(10): 1157. Anaesthesia, 2008, Sep; 63(9): 1037.
16. Nelson, R., Tse, B., Edwards, S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br. J. Surg., 2005, Jun; 92(6): 673–680.
17. Andersen, J., Hjort-Jakobsen, D., Christiansen, P. S., et al. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br. J. Surg., 2007, Jul; 94(7): 890–893.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2009 Číslo 4
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Truncus Coeliacus Stenosis in Duodenopancreatectomy
- Neoplastic Thrombosis of the Inferior Vena Cava in Kidney Carcinoma
- Antimicrobial Treatment in Complicated Intraabdominal Infections – Current Situation
- The Role of Surgery in Crohn‘s Disease Treatment