Fast-track surgery: the Heidelberg experience.

Fast-track surgery is an interdisciplinary multimodal concept of minimally invasive surgery or new incision lines and "cutting old plaits" (e.g., the use of drains or tubes). It uses modern intraoperative anesthesia (e.g., fluid restriction) and analgesia, including new drugs and novel ways of administration (e.g., thoracic epidural analgesia) for postoperative pain relief, in combination with the immediate mobilization of the patient and early oral nutrition after the operation. This approach requires a cooperating team of motivated nurses, physiotherapists, anesthesiologists, and surgeons, in addition to continuous improvement of the processes involved. Moreover, extended patient education and information about the procedures and the expected time course are of the highest importance, as the active role of the patient is to be emphasized. This chapter describes the development and implementation of fast-track surgery in colorectal diseases at the Department of Surgery of the University Hospital of Heidelberg, Germany. Preliminary results of fast-track surgery suggest a significant and clear overall benefit for the patient. A shorter hospital stay and reduced systemic morbidity in addition to no increase in postoperative complications on an out-patient basis were found. However, to exclude a "bloody discharge" of the patients, thorough follow-up and quality control are mandatory. Although in the initial phase increased personnel care is necessary, in the new German reimbursement system with G-DRGs (German diagnosis-related groups) fast-track surgery seems to save resources in the long term.