Convalescence after colonic surgery with fast‐track <i>vs</i> conventional care

Jakobsen, Dorthe Hjort; Sonne, E.; Andreasen, Jakob; Kehlet, Henrik

doi:10.1111/j.1463-1318.2006.00995.x

Cited by 119 publications

(91 citation statements)

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“…The findings underpin the importance of early surgical rehabilitation embedded in the surgical peri-and post-operative fast-track concept [13]. Within colorectal surgery, research in evidence-based fast-track regimes has revealed well documented effects internationally with regard to rapid recovery and reduced hospitalization [14][15][16]. The fast-track concept has gained wide acceptance internationally and is seen today as a standardized multimodal surgical rehabilitation program [17].…”

Section: 'Fast-track' -A Multimodal Rehabilitation Programmentioning

confidence: 99%

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark

et al. 2016

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Background Systematic assessments of cancer patients' rehabilitation needs are a prerequisite for devising appropriate survivorship programs. Little is known about the fit between needs assessment outlined in national rehabilitation policies and clinical practice. This study aimed to explore clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation of physical, psychological and social rehabilitation needs initially and at end of treatment was evident in 10% (n ¼ 2) of surgical patient trajectories and 35% (n ¼ 7) of oncology trajectories. Physical rehabilitation needs were documented among 90% (n ¼ 36) of all patients. Referral to municipal rehabilitation services was documented among 5% (n ¼ 2) of all patients. Assessments at surgical departments were shaped by the inherent continuous assessment of rehabilitation needs within standardized fast-track colorectal cancer surgery. In contrast, the implementation of locally developed assessment tools inspired by the distress thermometer (DT) in oncology departments was challenged by a lack of competencies and funding, impeding integration of data into patient files. Conclusion Consensus must be reached on how to ensure more systematic, comprehensive assessments of rehabilitation needs throughout clinical cancer care. Fast-track surgery ensures systematic documentation of physical needs, but the lack of inclusion of data collected by the DT in oncological departments questions the efficacy of assessment tools and points to a need for distinguishing between surgical and oncological settings in national rehabilitation policies.

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Section: 'Fast-track' -A Multimodal Rehabilitation Programmentioning

confidence: 99%

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark

et al. 2016

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“…Fatigue is pronounced after major abdominal surgery, probably because of inflammatory response. 15,20,56 Despite a multimodal analgesia regime, including thoracic epidural with local anesthetics and oral NSAIDs, a large proportion of patients experienced moderate to severe pain in the abdominal area during mobilization. Thus, 13%-20% of the patients reported pain as the main barrier to independent mobilization on PODs 2-7.…”

Section: Barriers To Independent Mobilizationmentioning

confidence: 99%

“…8,10,12 Early mobilization and exercise are known to play important roles in postoperative care following abdominal surgery and are associated with less postoperative reduction of fitness and fewer postoperative complications in patients undergoing elective surgery. 9,[15][16][17][18][19][20] There are, to our knowledge, no published data on postoperative physical performance, level of 24-hour physical activity, or barriers to independent mobilization within the first week following AHA surgery. Such findings are crucial when organizing strategies for enhanced recovery programs after AHA surgery.…”

mentioning

confidence: 99%

“…7 A focus on enhanced recovery programs specifically for patients following AHA surgery is needed to improve the postoperative outcome. [8][9][10][11][12][13][14][15] Possible interventions include reducing time before surgery, the early use of antibiotics, optimized fluid management, pain treatment, early nutrition and early mobilization. 8,10,12 Early mobilization and exercise are known to play important roles in postoperative care following abdominal surgery and are associated with less postoperative reduction of fitness and fewer postoperative complications in patients undergoing elective surgery.…”

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confidence: 99%

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Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Jønsson

Ingelsrud

Tengberg

et al. 2018

cjs

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Background: Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Methods:Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization.Results: Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Conclusion:Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.Contexte : La chirurgie abdominale d'urgence à risque élevé est associée à un fort taux de mortalité, à des complications postopératoires multiples et à des hospitalisations prolongées. Il est donc nécessaire d'élaborer de nouvelles stratégies pour amélio-rer le rétablissement après ce type de chirurgie. La présente étude visait à décrire le fonctionnement physique et les obstacles aux déplacements autonomes chez les patients ayant subi une chirurgie de ce type (jours postopératoires 1 à 7).Méthodes : Nous avons recruté successivement les patients subissant une chirurgie abdominale d'urgence à risque élevé dans un hôpital universitaire du Danemark. Durant la première semaine postopératoire, tous les patients ont subi quotidiennement une évaluation visant à vérifier leur fonctionnement physique. Nous nous sommes servis du Cumulated Ambulation Score (CAS; de 0 à 6 points) pour évaluer la mobilité de base et du moniteur activPAL pour évaluer le niveau d'activé physique 24 heures par jour. Nous avons noté les obstacles aux déplacements autonomes.Résultats : Cinquante patients (âge moyen : 61,4 ans ± 17,2) ont été retenus. Sept sont décédés durant la première semaine postopératoire, et 15 des 43 patients restants (35 %) ne se déplaçaient pas encore de façon autonome (CAS < 6) le septième jour, une situation associée à l'apparition de c...

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“…Studies showed reduction in hospital stay, reducing ileus and cardiopulmonary complications. 10,[13][14][15][16][17][18][19][20][21][22][23] Also in rectal cancer surgery the peri-operative "fast-track" multimodal rehabilitation program is effective and safe. 24,25 Randomised controlled trials (RCT) have showed the same results, 19,20,22,23,[27][28][29] though Behrns patients were discharged on liquid diets.…”

Section: Erasmentioning

confidence: 99%

Preoperative Preparation in Colorectal Surgery

Mohn¹

2012

Contemporary Issues in Colorectal Surgical Practice

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Convalescence after colonic surgery with fast‐track vs conventional care

Abstract: A fast-track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection.

Cited by 119 publications

References 10 publications

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark

Physical performance following acute high-risk abdominal surgery: a prospective cohort study

Preoperative Preparation in Colorectal Surgery

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