Evaluation of a fast-track programme for patients undergoing liver resection.

نویسندگان

  • N A Schultz
  • P N Larsen
  • B Klarskov
  • L M Plum
  • H J Frederiksen
  • B M Christensen
  • H Kehlet
  • J G Hillingsø
چکیده

BACKGROUND Recent developments in perioperative pathophysiology and care have documented evidence-based, multimodal rehabilitation (fast-track) to hasten recovery and to decrease morbidity and hospital stay for several major surgical procedures. The aim of this study was to investigate the effect of introducing fast-track principles for perioperative care in unselected patients undergoing open or laparoscopic liver resection. METHODS This was a prospective study involving the first 100 consecutive patients who followed fast-track principles for liver resection. Catheters and drains were systematically removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. Discharge criteria were: pain sufficiently controlled by oral analgesics alone, patient comfortable with discharge and no untreated complications. RESULTS Median length of stay (LOS) for all patients was 5 days, with 2 days after laparoscopic versus 5 days following open resection (P < 0·001). Median LOS after minor open resections (fewer than 3 segments) was 5 days versus 6 days for major resections (3 or more segments) (P < 0·001). Simple right or left hemihepatectomies had a median LOS of 5 days. The readmission rate was 6·0 per cent and 30-day mortality was zero. CONCLUSION Fast-track principles for perioperative care were introduced successfully and are safe after liver resection. Routine discharge 2 days after laparoscopic resection and 4-5 days after open liver resection may be feasible.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

FDG-PET/MRI fused data sets for the detection of liver metastases in patients undergoing systemic anticancer treatment

Background: To retrospectively describe imaging characteristics of liver metastases on fused FDG-PET/ MRI data sets and to compare the diagnostic accuracy of MRI and fused FDG-PET/MRI data sets for the detection of liver metastases in patients undergoing systemic anticancer treatment. Materials and Methods: 43 oncological patients (mean age: 56+/- 11 years) were investigated by FDG-PET...

متن کامل

Restoring integrity—A grounded theory of coping with a fast track surgery programme

AIMS AND OBJECTIVES The aim of this study was to generate a theory conceptualizing and explaining behavioural processes involved in coping in order to identify the predominant coping types and coping type-specific features. BACKGROUND Patients undergoing fast track procedures do not experience a higher risk of complications, readmission, or mortality. However, such programmes presuppose an in...

متن کامل

Implementation of Enhanced Recovery Programme for Colorectal Surgery from the Economical Perspective

Aim: To confirm the applicability of fast-track program in patients undergoing laparoscopic colorectal surgery and to analyze the economic impact. Methods: Laparoscopic surgery and the implementation of the "fast track" program have radically changed patient management during the last 20 years. In a time of limited financial resources and health expenditure control, the importance of a cost-eff...

متن کامل

Risk of venous thrombosis in patients with hepatic malignancies undergoing surgical resection.

The risk of venous thrombosis is well documented in patients with malignancies, those undergoing abdominal surgery, and those undergoing hepatic resection for malignancy. This study was undertaken to determine whether there was a difference in the risk of thrombosis between those undergoing resection for hepatic metastases and primary hepatic malignancies. We performed a retrospective chart rev...

متن کامل

Implementing a fast-track protocol for patients undergoing bowel resection: not so fast.

BACKGROUND Multimodality fast-track protocols have been shown to enhance recovery after bowel resection. However, it remains unclear which of the components impact outcomes and whether processes actually occur as intended. METHODS Consecutive patients who underwent elective bowel resection at a university teaching hospital under a standardized fast-track recovery protocol were compared with p...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • The British journal of surgery

دوره 100 1  شماره 

صفحات  -

تاریخ انتشار 2013