Background
Fast Track (FT) is a multimodal perioperative approach which aims to optimize physiologic response to the surgical stress and consequently improve postoperative outcome. Our goal was to analyse the effect of compliance to the FT protocol on postoperative outcome and to identify specific FT measures able to influence outcome.
Patients
This retrospective study involves a cohort of consecutive patients who underwent colorectal surgery within a FT protocol between 2007 and 2013. Besides basic demographics, adherence to protocol, postoperative complications and postoperative hospital stay (POHS) were recorded. Both univariate and multivariate analysis were performed to determine the effect of the FT protocol compliance and of specific FT items on surgical outcome and POHS.
Results
There were 157 men and 127 women with a mean age of 59 years. Compliance to the FT protocol reached a median of 18 out of 19 items. The median hospital stay was 3 days (2 – 49). Overall complications rate was 34.9% and 7.4% when Dindo-Clavien classification > 2 was considered. Risk factors of postoperative complications were male sex (p=0.038), laparotomy (p=0.015), neoplasia (p=0.007) and number of comorbidities (p=0.009). Higher compliance to the FT protocol is associated with a reduction of the complication rate (p<0.001), the severity of complication (p=0.002) and the POHS (p<0.001). We have not been able to identify a higher risk of postoperative influence of any specific FT measure.
Conclusion
Greater adherence to FT protocol is associated with a decreased risk of postoperative complications and POHS. Our results suggest an application of the protocol as a whole improves postoperative outcome.