Randomized clinical trial of multimodal optimization and standard perioperative surgical care

• Published in: British journal of surgery 2003-12, Vol.90 (12), p.1497-1504
• Main Authors: Anderson, A. D. G., McNaught, C. E., MacFie, J., Tring, I., Barker, P., Mitchell, C. J.
• Format: Article
• Language: English
• Subjects: Aged; Analgesics - administration & dosage; Biological and medical sciences; Clinical Protocols; Colectomy - methods; Colonic Diseases - physiopathology; Colonic Diseases - surgery; Early Ambulation; Fatigue - etiology; Female; Forced Expiratory Volume - physiology; Hand Strength; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Pain, Postoperative - prevention & control; Pain, Postoperative - psychology; Perioperative Care - methods; Postoperative Complications; Recovery of Function; Severity of Illness Index; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Technology. Biomaterials. Equipments; Time Factors; Treatment Outcome
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4371

Background: Multimodal optimization of surgical care has been associated with reduced hospital stay and improved physical function. The aim of this randomized trial was to compare multimodal optimization with standard care in patients undergoing colonic resection. Methods: Twenty‐five patients requiring elective right or left hemicolectomy were randomized to receive a ten‐point optimization programme (14 patients) or conventional care (11). The groups were similar in terms of age (64 versus 68 years), male : female sex ratio (6 : 8 versus 5 : 6) and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score (both 26). Outcome measures were recorded before operation and on postoperative days 1, 7 and 30. They included hand grip strength, lung spirometry, and pain and fatigue scores. Further outcome measures included time to achieve a predetermined mobilization target, time to resumption of normal diet, and length of stay. Results: Optimization was associated with maintained grip strength, earlier mobilization (46 versus 69 h; P = 0·043), and significantly lower pain and fatigue scores. Patients in the optimization group tolerated a regular hospital diet significantly earlier than controls (48 versus 76 h; P < 0·001). Optimization significantly reduced the median length of hospital stay (3 versus 7 days; P = 0·002). Conclusion: Optimization of surgical care significantly improved patients' physical and psychological function in the early postoperative period and facilitated early hospital discharge. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Multimodal care plan improves outcome