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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. What is Fast Track Surgery?. synonyms : - accelerated recovery program

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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

slide2
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

reduce:

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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ASA-criteria

Patient data

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Diagnoses

conv.care

fast-track

slide8
Operation technique

conv.care

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

slide16
Fast track and open surgery:

complications

total open surgeries: n = 16

total complications: n = 4

slide17
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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