Postoperative care in fast‐track rehabilitation for elective colonic surgery

SUMMARY The success of a ‘fast‐track’ rehabilitation program in colonic surgery depends on multiple factors. The major factor post surgery is the prevention of postoperative ileus (POI), resulting in a faster recovery and a shorter hospital stay. All fast‐track programs led to an accelerated intake of oral fluids and solid foods and normalization of intestinal function, thus reducing both the primary and overall hospital stay. Fortunately, the postoperative treatment was not accompanied by an increase in morbidity or mortality. Nevertheless, fast‐track surgery may mean a higher rate of hospital readmissions in the first 2 weeks after discharge. Besides the prevention of POI and postoperative nausea and vomiting through restricted intraoperative fluid management, early oral food intake, rigorous pain control and early mobilization, education – on the part of patient, nurses and other medical staff – is equally as important. Ensuring that the patient takes an active rather than a passive role in the recovery process empowers the patient and avoids needless suffering. The patient is thus surrounded by encouraging staff members who motivate him or her not as a patient but as a ‘partner’ in a precarious situation. Early oral food intake and early mobilization suggest to the patient (and, possibly, to the nursing staff) that the surgical procedure was less invasive than believed and that the postoperative phase need not be eventful or traumatic. In contrast to the conventional treatment with infusions, the typical postoperative diet consisting of tea and soup for days, the fast‐track protocol gives the patient the feeling that he or she is actually in good health and about to leave the hospital. All optimistic signals received during the postoperative phase undoubtedly have a very suggestive and positive influence psychologically on the patient. It is therefore reasonable to assume that the psychological effect of fast‐track rehabilitation, although not assessed in clinical trials, is very important and influences the recovery substantially. Good clinical practice should be based on an ongoing audit of the outcome. In order to ensure the success of a fast‐track rehabilitation program in surgery, it is essential to assess the outcome in terms of morbidity and mortality. Moreover, such an ambitious protocol has to take into account new clinical trial findings in order to introduce improvements to the postoperative phase. Besides an understanding of the pathophysiology and new therapeutic approaches to prevent POI and improve pain control, such measures include the development of an intradepartmental infrastructure and staff education initiatives.