Fast track--different implications in pancreatic surgery

Concepts in "fast-track" surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resect...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2007-07, Vol.11 (7), p.880-887
Main Authors: Berberat, P O, Ingold, H, Gulbinas, A, Kleeff, J, Müller, M W, Gutt, C, Weigand, M, Friess, H, Büchler, M W
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Female
Hospitals
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Multivariate analysis
Pancreatectomy - adverse effects
Pancreatectomy - methods
Pancreatic Diseases - surgery
Patient Discharge - statistics & numerical data
Postoperative Complications - epidemiology
Surgery
Time Factors
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Summary:Concepts in "fast-track" surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models. Of the 255 patients, 180 received a pancreatic head resection and 51 received distal, 15 received total, and 9 received segmental pancreatectomies. The patients were discharged on median day 10 with a 30-day readmission rate of 3.5%. The in-hospital mortality was 2%, whereas medical and surgical morbidities were 17 and 25%, respectively. Fast-track parameters, such as first stools, normal food, complete mobilization, and return to normal ward, correlated significantly with early discharge (p < 0.05). Patients' age, operation time, and early extubation proved to be independent factors of early discharge, shown through multivariate analysis (odds ratio: 4.0, 2.0, and 2.8, respectively; p < 0.05). Low readmission, mortality, and morbidity rates demonstrate that fast-track surgery is in fact feasible and safe and promotes earlier discharge without compromising patient outcomes.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-007-0167-2