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Fast-track vs standard care in colorectal surgery: a meta-analysis update

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Abstract

Background

Fast-track (FT) protocols accelerate patient's recovery and shorten hospital stay as a result of the optimization of the perioperative care they offer. The aim of this review is to examine the latest evidence for fast-track protocols when compared with standard care in elective colorectal surgery involving segmental colonic and/or rectal resection.

Materials and methods

All randomized controlled trials and controlled clinical trials on FT colorectal surgery were reviewed systematically. The main end points were short-term morbidity, length of primary postoperative hospital stay, length of total postoperative stay, readmission rate, and mortality. Quality assessment and data extraction were performed independently by two observers.

Results

Eleven studies were eligible for analysis (four randomized controlled trials (RCTs) and seven controlled clinical trials (CCT)), including 1,021 patients. Primary hospital stay (weighted mean difference −2.35 days, 95% confidence interval (CI) −3.24 to −1.46 days, P < 0.00001) and total hospital stay (weighted mean difference −2.46 days, 95% CI −3.43 to −1.48 days, P < 0.00001) were significantly lower for FT programs. Morbidity was also lower in the FT group. Readmission rates were not significantly different. No increase in mortality was found.

Conclusions

FT protocols show high-level evidence on reducing primary and total hospital stay without compromising patients' safety offering lower morbidity and the same readmission rates. Enhanced recovery programs should become a mainstay of elective colorectal surgery.

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College, St. Mary’s Hospital, 10th Floor, QEQM, Praed Street, London, W2 1NY, UK

    Nikolaos Gouvas, Emile Tan & Paris P. Tekkis

  2. Medical School, University of Crete, Heraklion, Greece

    Nikolaos Gouvas & Evaghelos Xynos

  3. Department of Colorectal Surgery, University College Hospital, London, UK

    Alistair Windsor

Authors
  1. Nikolaos Gouvas
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  2. Emile Tan
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  3. Alistair Windsor
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  4. Evaghelos Xynos
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  5. Paris P. Tekkis
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Correspondence to Paris P. Tekkis.

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Gouvas, N., Tan, E., Windsor, A. et al. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 24, 1119–1131 (2009). https://doi.org/10.1007/s00384-009-0703-5

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