Open Right-sided Colonic Fast-track Surgery is Associated with Shorter Hospital Stay but more Re-admissions
Abstract Background: Fast-track (FT) surgery programs – based on recognized clinical guidelines including opioid and fluid restriction, epidural analgesia, and early mobilization – have been introduced to optimize patient recovery after various surgical procedures. This study was designed to evaluate – with respect to hospital stay, complications, and re-admission rate – a local FT program for patients undergoing open right-sided hemi colectomy at a large urban university hospital in southern Sweden. Methods: We compared retrospectively 86 study patients subjected to open right-sided hemi colectomy after implementation of the FT program (January 2006 – December 2007) with 86 control patients, matched for gender and age, before implementation (January 2000 – February 2005). Patient records were used as the primary source of data. Total hospital stay was the primary endpoint. Secondary endpoints were re-admission, reoperation, complication, and mortality rates. Results: Median total hospital stay was shorter in study compared with control patients (7 vs. 9 days; P<0.001), but more study than control patients were re-admitted within 30 days (9.3% vs. 2.3%; P=0.046). The patient groups did not differ in reoperation, complication, or mortality rates. Conclusion: This study has shown that clinical implementation of an FT program was associated with shorter hospital stay after open right-sided hemi colectomy, however at the price of more patient re-admissions. Fast-track programs should be evaluated with particular emphasis on hospital re-admissions, and specific measures be taken to identify high-risk patients not to discharge them too early.