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

Vanessa Hui, Neil Hyman, Christopher Viscomi, Turner Osler

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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 patients who underwent similar procedures before protocol initiation. Compliance was measured with the 7 major elements of the protocol: administration of nonopioid analgesia, perioperative lidocaine, nasogastric tube removal, early feeding, early ambulation, and fluid restriction. Results: Eighty pathway patients were compared with 87 conventional patients. Only 3 of the 7 major components were successfully implemented. Fluid restriction was achieved in only 2 patients. Pain scores and ileus-related morbidities were comparable with the exception of nasogastric tube reinsertion, which was required twice as often in pathway patients (17 vs 8, P =.02). Thirteen pathway patients were readmitted compared with 7 control patients (P =.11). Conclusions: The delivery of expected care cannot be assumed. There was no discernible benefit in patient outcomes.

Original languageEnglish (US)
Pages (from-to)152-158
Number of pages7
JournalAmerican journal of surgery
Volume206
Issue number2
DOIs
StatePublished - Aug 2013
Externally publishedYes

Keywords

  • Compliance
  • Ileus
  • Pathway

ASJC Scopus subject areas

  • Surgery

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