Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial

Table 1 Principles of fast track rehabilitation program and conventional care

	Fast track rehabilitation program	Conventional care
Preoperative	Patients and their relatives	Patient were educated in the standard manner
	were informed about the surgical procedure and postoperative course
Day before surgery
Bowel preparation	No bowel preparation was performed	Two oral sachets of fleet® bowel preparation
Carbohydrate load	4 units (preOp®)	No
Diet	Last meal 6 h before operation	Last meal at midnight
Day of surgery
Pre-operative fasting	No, 2 units (preOp®) 2 h before surgery	Yes
Nasogastric tubes	No unless nausea and vomit	Routine placement
Pre-anesthetic medication	No	Oral diazepam 10 mg
Anesthesia	General anesthesia	General anesthesia
	Remifentanil 1 μg/kg per minute	Remifentanil 1 μg/kg per minute
	Propofol 2-4 mg/kg per hour	Propofol 2-4 mg/kg per hour
	Cisatracium 0.15 mg/kg	Cisatracium 0.15 mg/kg
	Ondansetron 4 mg	Ondansetron 4 mg
	Bupivacaine 0.25% 20 mL (incision)
	Epidural catheter
	T10-T12
	Test: 3 mL 2% lidocaine with epinephrine
	Bupivacaine 0.5% (6 + 6) mL
Surgical management	Minimal invasive incision	Median laparotomy approach
	Infiltration of surgical wounds with Bupivacaine	No infiltration of surgical wounds with local anesthetic drugs
Surgical drains	No, unless required in circumstances and discarded in early time (usually on postoperative day 1)	Routine placement usually discarded the day before discharge
Early post-operative care	Use of epidural catheter (0.125% Bupivacaine with 2.5 μg/mL Fentanyl)	Analgesia by bolus administration of diclofenac or morphine
	First oral drink 2 h after surgery	No oral application scheme
	IV infusion of Ringers lactate 1.5 L/d	IV infusion of Ringers lactate 2.5 L/d
	Mobilization in the evening (> 2 h out of bed)	No mobilization scheme
Postoperative care
Day 1 after surgery	Oral intake > 2 L (including 4 units CHL liquids)	Diet increased on daily basis
	Semi-solid food intake	IV fluid administration (2.5 L/d) till adequate oral fluid intake
	Stop IV fluid administration	Mobilization according to attending surgeon
	Remove urine catheter
	Expand mobilization (> 6 h out of bed)
Day 2 after surgery	Remove epidural add Diclofenac 3 × 50 mg/d	Continue as on day 1 till discharge criteria fulfilled
	Normal diet
	Expand mobilization (> 8 h)
	Plan discharge
Day 3 after surgery	Continue as on day 2 till discharge criteria fulfilled	Continue as on day 2 till discharge criteria fulfilled

Table 2 Characteristics of patients and their diagnosis

	Fast track rehabilitation group (n = 106)	Conventional care group (n = 104)	P value
Median age (range, yr)	57 (38-69)	55 (40-67)	0.462
Male/female	65/41	60/44	0.393
Colon/rectum	73/33	63/41	0.110
ASA score			0.384
I	27	32	-
II	60	56	-
III	19	16	-
Operation			0.721
Right hemicolectomy	30	24
Left hemicolectomy	18	26
Sigmoid colectomy	28	32
Anterior resection	30	22
TNM stage			0.741
I	19	17
II	56	61
III	31	26

Table 3 Postoperative rehabilitation and hospital stay time of two groups n (%)

	Fast track rehabilitation group (n = 106)	Conventional care group (n = 104)	P value
Walk on surgery day	11 (35)	0 (0)	0.001
Walk on D 1	56 (53)	24 (23)	0.000
Walk on D 2	90 (85)	61 (59)	0.001
Days until flatus			0.001
mean ± SD	2.1 ± 2.0	3.2 ± 2.5	-
Median (range)	2 (1-6)	3 (1-8)	-
Hospital stay time (d)			0.001
mean ± SD	5.1 ± 3.1	7.6 ± 4.8	-
Median (range)	5 (2-41)	7 (3-55)	-

Table 4 General and surgical complications of two groups

	Fast track rehabilitation group (n = 106)	Conventional care group (n = 104)	P value
Overall complications	20	39	0.015
Patients with complications	14	28	0.016
General complications	10	23	0.042
Patients with general complications	7	16	0.048
Cardiac	2	5	-
Pulmonary	3	8	-
Thromboembolic	1	3	-
Urinary tract	2	5	-
Other	2	2	-
Overall surgical complications	10	16	0.221
Patients with surgical complications	7	12	0.230
Wound infection	4	7	-
Anastomotic leakage	4	2	-
Bowel obstruction	2	5	-
Death	2	1	0.572