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Systematic review of enhanced recovery programmes in colonic surgery. BJS 2006; 93: 800-809.

Published: 14th June 2006

Authors: J. Wind, S. W. Polle, P. H. P. Fung Kon Jin, C. H. C. Dejong, M. F. von Meyenfeldt, D. T. Ubbink et al.

Background

Fast track (FT) programmes optimize perioperative care in an attempt to accelerate recovery, reduce morbidity and shorten hospital stay. The aim of this review was to assess FT programmes for elective segmental colonic resections.

Method

A systematic review was performed of all randomized controlled trials and controlled clinical trials on FT colonic surgery. The main endpoints were number of applied FT elements, hospital stay, readmission rate, morbidity and mortality. Quality assessment and data extraction were performed independently by three observers.

Results

Six papers were eligible for analysis (three randomized controlled and three controlled clinical trials), including 512 patients. FT programmes contained a mean of nine (range four to 12) of the 17 FT elements as defined in the literature. Primary hospital stay (weighted mean difference − 1·56 days, 95 per cent confidence interval (c.i.) − 2·61 to − 0·50 days) and morbidity (relative risk 0·54, 95 per cent c.i. 0·42 to 0·69) were significantly lower for FT programmes. Readmission rates were not significantly different (relative risk 1·17, 95 per cent c.i. 0·73 to 1·86). No increase in mortality was found.

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