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The Fast Track Concept in Colo-rectal Surgery

SMZ Floridsdorf, Vienna, Austria. The Fast Track Concept in Colo-rectal Surgery. A. Tuchmann, P. Razek, C. Kienbacher, P. Patri, K. Pinnisch, . Hospital Floridsdorf, Vienna, Austria. What is Fast Track Surgery?. synonyms : - accelerated recovery program

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The Fast Track Concept in Colo-rectal Surgery

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  1. SMZ Floridsdorf, Vienna, Austria The Fast Track Concept in Colo-rectal Surgery A. Tuchmann, P. Razek, C. Kienbacher, P. Patri, K. Pinnisch, Hospital Floridsdorf, Vienna, Austria

  2. What is Fast Track Surgery? synonyms: - accelerated recovery program - ERAS: enhanced recovery after surgery Prof Henrik Khelet, Kopenhagen, DK; 1989 Definition: a concept for acceleration of postoperative convalescence by a multimodal rehabilitation program

  3. Modified W. Schwenk und J.M. Müller: Was ist "Fast-track"-Chirurgie? Deutsche Medizinische Wochenschrift 2005; 130 (10): 536-540 optimal pain relief (EDC) accelerated convalescence perioperative fluid restriction reduction of overall complications reduce: stress response organ dysfunction early enteral nutrition shorter hospital stay early postoperative mobilization increased patient comfort minimal use of tubes, drains, and catheters

  4. Pre- and perioperative period • oral and written information about the surgery and postoperative procedure by attending surgeon in our outpatient clinic • information about epidural catheter (EDC) and epidural analgesia by anaesthesiologist • admission one day prior to surgery • preoperative oral bowel preparation (Macrogol 3350), oral intake of clear fluids until 2 hours preoperative • EDC placement in operating theatre • postoperative mobilization ~ 5 hrs. after surgery • free oral intake of fluids; yogurt or 2 protein drinks • opioids and local anaesthetics through EDC

  5. Postoperative period day 1: continuous pain management per EDC removal of urinary bladder catheter mobilization ≥ 8 hrs mashed food metamizole or paracetamole to relieve pain day 2: normal oral intake full mobilization removal of EDC NSAIDs orally on demand day 3-5: planned discharge day 8: checkup in the outpatient clinic, information on histological findings

  6. ASA-criteria Patient data

  7. Diagnoses conv.care fast-track

  8. Operation technique conv.care fast-track

  9. postop. stay  7 66% Results

  10. Major complications

  11. Treatment of major complications

  12. Minor complications

  13. Readmissions (Fast-Track)

  14. Mortality

  15. A view at surgical tradition and suspected disadvantages no bowel cleansing……………..anastomotic failure early oral feeding………………..vomiting / aspiration / pneumonia anastomotic failure no drainage……………………….retention, insufficiency no parenteral fluids………………thrombosis, renal failure enforced mobilization……………fatigue, exhaustion

  16. Fast track and open surgery: complications total open surgeries: n = 16 total complications: n = 4

  17. Summary I The fast track concept is 1. feasible at - Hospital Floridsdorf (hospital of the community of Vienna) - with non selected patients undergoing - colorectal surgery (open / lap.) 2. advantages: - reduction of general complications - accelerated convalescence - shorter hospital stay - patient satisfaction

  18. SMZ Floridsdorf, Vienna, Austria Summary II 3. unchanged: - local complications 4. caution: - readmissions 5. question and hope: - reduction of costs - less immunosuppression - better oncologic results

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