Search

Background & Aims: A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care (fluid restriction, optimized analgesia, forced mobilization, and early oral feeding) to reduce perioperative morbidity, hospital stay, and cost. We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery. Methods: A randomized trial of patients in 4 teaching hospitals in Switzerland included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or standard care. The primary end point was the 30-day complication rate. Secondary end points were severity of complications, hospital stay, and compliance with the fast-track protocol. Results: The fast-track protocol significantly decreased the number of complications (16 of 76 in the fast-track group vs 37 of 75 in the standard care group; P = .0014), resulting in shorter hospital stays (median, 5 days; range, 2–30 vs 9 days, respectively; range, 6–30; P < .0001). There was a trend toward less severe complications in the fast-track group. A multiple logistic regression analysis revealed fluid administration greater than the restriction limits (odds ratio, 4.198; 95% confidence interval, 1.7–10.366; P = .002) and a nonfunctioning epidural analgesia (odds ratio, 3.365; 95% confidence interval, 1.367–8.283; P = .008) as independent predictors of postoperative complications. Conclusions: The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as standard care. Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program. [Copyright &y& Elsevier]

Objectives: One-lung ventilation (OLV) during thoracoscopic surgery is associated with a significant decline in arterial PO2 in patients with severe pulmonary emphysema and patients with preserved lung function. The authors hypothesized that patterns of arterial PO2 changes are different in these 2 patient groups. Design: Prospective nonrandomized study. Setting: University hospital. Participants: Twenty-five patients undergoing thoracoscopic interventions: 16 with severe pulmonary emphysema and 9 patients without emphysema. Interventions: Continuous arterial blood gas measurement (PaO2, PaCO2, pHa) during OLV of the left lung in left lateral position using the Paratrend 7 blood gas monitoring system (PT7; Pfizer Hospital Products Group, High Wycombe, UK). Main Results: The decrease of PaO2 was delayed in patients with severe emphysema. Steady state (defined as ΔPaO2 <7.5mmHg/min) was reached after 18 ± 4 minutes compared with 11 ± 3 minutes (mean ± standard deviation) in patients with normal lung function (p = 0.0002). PaO2 values at steady state were comparable (p = 0.49); the pattern of changes in PaO2 for the first 15 minutes of left-sided OLV was significantly different between the groups (p = 0.0004). The difference of predicted versus measured PaO2 at steady state was −48 ± 160 mmHg for patients with emphysema and −51 ± 60 mmHg for patients with normal lung function (p = 0.019). Conclusion: During OLV, oxygenation is better preserved for a longer period of time in patients with severe pulmonary emphysema as compared with patients with normal lung function. In contrast to patients without emphysema, prediction of oxygenation during OLV for the individual patient with emphysema is unreliable because of large interindividual differences. [Copyright &y& Elsevier]