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The Fast Track Concept in Colo-rectal Surgery PowerPoint PPT Presentation

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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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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

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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

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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


stress response

organ dysfunction

early enteral nutrition

shorter hospital stay

early postoperative mobilization

increased patient comfort

minimal use of tubes, drains, and catheters

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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

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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

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Patient data

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Operation technique


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postop. stay  7 66%


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Major complications

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Treatment of major complications

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Minor complications

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Readmissions (Fast-Track)

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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

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Fast track and open surgery:


total open surgeries: n = 16

total complications: n = 4

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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

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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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