Convalescence after colonic surgery with fast-track vs conventional care

Objective To compare convalescence after colonic surgery with a fast‐track rehabilitation programme vs conventional care. Background Introduction of a multimodal rehabilitation programme (fast‐track) with focus on epidural anaesthesia, minimal invasive surgical techniques, optimal pain control, and early nutrition and mobilization together with detailed patient information have led to a shorter hospital stay after colonic surgery. There are not much data on convalescence after discharge. Methods A prospective, controlled, non‐randomized interview‐based assessment in 160 patients undergoing an elective, uncomplicated, open colonic resection or the Hartmann reversal procedure with a fast‐track or a conventional care programme in two university hospitals. A structured interview‐based assessment was performed preoperatively, and day 14 and 30 postoperatively. Results Patients undergoing colonic surgery with a fast‐track programme regained functional capabilities earlier with less fatigue and need for sleep compared with patients having conventional care. Despite early discharge of the fast‐track patients (mean 3.4 days vs 7.5 days), no differences were found according to the need for home care, social care and visit to general practitioners, although the fast‐track group had an increased number of visits at the outpatient clinic for wound care. More patients in the fast‐track group were re‐admitted, but the overall mean total hospital stay was 4.2 days vs 8.3 days in the conventional group. Conclusion A fast‐track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection.