Implementation of a fast-track perioperative care program: what are the difficulties?

BACKGROUND To evaluate the feasibility of a fast-track (FT) program and it's effect on postoperative recovery. METHODS All patients, scheduled for elective segmental colorectal resection were treated in a FT program (FT group). Data were compared to a control group operated for elective colorectal resections and treated in a traditional care program (TC group). Data from the FT group were collected prospectively, data from the TC group retrospectively. Outcome parameters included the number of successfully applied FT modalities, patient satisfaction, morbidity rate, re-operation rate, primary (PHS) and total hospital stay (THS), and readmission rate. RESULTS One-hundred and seven patients were included (55 FT group vs. 52 TC group). The groups were comparable for patient characteristics such as age and cr-POSSUM score (p = 0.22 and p = 0.40). An average of 7.4 of 13 predefined FT modalities were successfully achieved per patient. Patient satisfaction was comparable (p = 0.84). Seven versus 5 patients required a re-operation in the FT and TC groups, respectively (p = 0.52). Morbidity rate was comparable (n = 16 vs. 15, p = 0.83). Median PHS was 4.0 vs. 6.0 days and median THS was 4.0 vs. 6.5 days in the FT and TC groups (p < 0.01 and p < 0.03, respectively). Six vs. 3 patients were re-admitted in the FT and TC groups, respectively (p = 0.49). CONCLUSION Implementation of all FT modalities was difficult since a rather low number of pre-defined FT modalities was effectively realized. Despite incomplete implementation, PHS and THS were shorter in the FT group without affecting patient satisfaction.