Schwenk Wolfgang, Flemming Sven, Girona-Johannkämper Monsserat, Wendt Wolfgang, Darwich Ibrahim, Strey Christoph
Gesellschaft für Optimiertes perioperatives Management, GOPOM GmbH, Düsseldorf, Deutschland.
Gesellschaft für Optimiertes Perioperatives Management GOPOPM GmbH, Oberlörickerstr. 390b, 40547, Düsseldorf, Deutschland.
Chirurgie (Heidelb). 2024 Feb;95(2):148-156. doi: 10.1007/s00104-023-01986-8. Epub 2023 Nov 10.
Multimodal optimized perioperative management (mPOM, fast-track, enhanced recovery after surgery, ERAS) leads to a significantly accelerated recovery of patients with elective colorectal resections. Nevertheless, fast-track surgery has not yet become established in everyday clinical practice in Germany. We present the results of a structured fast-track implementation in five German hospitals.
Prospective data collection in the context of a 13-month structured fast-track implementation. All patients ≥ 18 years undergoing elective colorectal resection and who gave informed consent were included. After 3 months of preparation (pre-FAST), fast-track treatment was initiated and continued for 10 months (FAST). Outcome criteria were adherence to internationally recommended fast-track elements, postoperative complications, functional recovery, and postoperative hospital stay.
Data from 192 pre-FAST and 529 FAST patients were analyzed. Age, sex, patient risk, location, and type of disease were not different between both groups. The FAST patients were more likely to have undergone minimally invasive surgery (82% vs. 69%). Fast-track adherence increased from 52% (35-65%) under traditional treatment to 83% (65-96%) under fast-track treatment (p < 0.01). The duration until the end of infusion treatment, removal of the bladder catheter, first bowel movement, oral solid food, regaining autonomy, suitability for discharge and postoperative length of stay were significantly lower in the FAST group. Complications, reoperations, and readmission rates did not differ.
Fast-track adherence rates > 75% can also be achieved in German hospitals through structured fast-track implementation and the recovery of patients can be significantly accelerated.
多模式优化围手术期管理（mPOM，快速康复，术后加速康复，ERAS）可显著加速择期结直肠切除术患者的康复。然而，快速康复手术在德国的日常临床实践中尚未得到广泛应用。我们展示了在德国五家医院实施结构化快速康复的结果。
在为期13个月的结构化快速康复实施过程中进行前瞻性数据收集。纳入所有年龄≥18岁、接受择期结直肠切除术并签署知情同意书的患者。经过3个月的准备（术前快速康复阶段）后，开始快速康复治疗并持续10个月（快速康复阶段）。观察指标包括对国际推荐的快速康复要素的依从性、术后并发症、功能恢复情况以及术后住院时间。
分析了192例术前快速康复阶段患者和529例快速康复阶段患者的数据。两组患者的年龄、性别、患者风险、疾病部位和类型无差异。快速康复阶段的患者更有可能接受微创手术（82%对69%）。快速康复的依从性从传统治疗下的52%（35 - 65%）提高到快速康复治疗下的83%（65 - 96%）（p < 0.01）。快速康复组在输液治疗结束时间、拔除膀胱导管时间、首次排便时间、开始进食固体食物时间、恢复自主活动时间、出院适宜时间以及术后住院时间方面均显著缩短。并发症、再次手术和再入院率无差异。
通过结构化的快速康复实施，德国医院也能实现快速康复依从率>75%，并能显著加速患者康复。
