Fast Track Laparoscopic Surgery: A Study in a District Hospital

Angela Maurizi1, Francesco Falsetti2, Giorgio Degano2, Roberto Campagnacci2, Emanuele Lezoche3. 1Department of General Surgery, Universita Politecnica delle Marche, 60126 Ancona, Italy, 2General Surgery, ASUR Regione Marche, “Carlo Urbani” Hospital, Jesi, Ancona, 3Department of General Surgery, Surgical Specialties and Organ Transplantation “Paride Stefanini”, Azienda Policlinico Umberto I, Sapienza University of Rome, Italy

INTRODUCTION: Fast track program or enhanced recovery after surgery program is a set of protocols that involves multimodal approaches, including preoperative patient education, optimizing anesthesia, early postoperative enteral nutrition and early mobilization. The purpose of this program is to improve clinical outcomes when compared with traditional care strategies, reducing the postoperative morbidity and shortening the hospital stay. Although enhanced recovery after surgery protocol in colorectal surgery has been promoted as a standard, its thorough application is still scarce, due to difficulties in overcoming cultural and organizational barriers that can hinder its start-up and diffusion. The purpose of this work is to analyze the possibility to apply the fast track protocol in patients undergoing colorectal surgery, laparoscopic resections in most cases, in a district hospital.

METHODS AND PROCEDURES: A prospective, randomized study on 90 patients subjected to colorectal surgery, particularly laparoscopic resections, was conducted in the last year. Patients were divided in two groups: on one hand the fast track group, undergoing pre-operation physiological preparation, epidural analgesia, minimally invasive surgery and early mobilization and feeding; on the other hand the control group that followed the standard treatment.

Data were analyzed using the T-test by Student with significance level p<0.05 and univariate analysis of the relations among the evaluated factors (e.g. post-operative hospital stay, total hospital stay, overall complications, readmission rates).

RESULTS: The fast track therapeutic protocol was respected in 92% of cases, which showed low general morbidity. There was no difference in post-operative complications between the fast track and the control group. The fast track protocol shortens hospital stay and accelerates the recovery of bowel function with no increase of post-operative complications.

CONCLUSIONS: The preliminary results of our survey confirm the applicability and safety of the “Fast Track Surgery”. As reported in related literature, compliance with the fast track procedure was good and morbidity occurrence in general was limited even in this survey conducted in a district hospital.

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