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1、REVIEWARTICLEFast-track surgery: procedure-specific aspects and future directionDaniel Ansari P0.05). Major medical morbidity was reduced to 2 % in the FT group compared with 14 % in the control (P0.01). The readmission rate was not increased. Uncontrolled cohort studies have documented the feasibil
2、ity of FT programs in vaginal prolapse surgery with hospital stays of less than 24 h and convalescence shortened to 13 weeks 71, 72. It has been shown that the expected clinical gains of introducing FT care in a gynecological department can be achieved without compromising the work load of the ward
3、staff 73.32Langenbecks Arch Surg (2013) 398:2937Thoracic surgeryOne RCT evaluated a FT treatment regimen for patients undergoing lung resections 74. The study included 58 patients, 30 in the FT group and 28 in the control. It was shown that the incidence of pulmonary complications was 6.6 % in the i
4、ntervention group as compared to 35 % in the control (P00.009). The length of stay was 11 days and was not significantly different between the groups.Vascular surgeryOne RCT reported 99 patients undergoing open infrarenal aneurysm repair with either an FT protocol or control 4. The need for postoper
5、ative mechanical ventilation was re- duced (P00.002) and medical complications decreased (P0 0.039). All patients received preoperative education and were immediately extubated in the operation room. No bowel preparation, no fasting, prevention of heat loss (op- eration room temperature of 22 C), ep
6、idural analgesia, nonsteroidal antiinflammatory drugs, intravenous fluids at 1,000 ml/24 h, early removal of tubes and catheters, and early ambulation and mobilization were part of the FT protocol. The length of stay in the intensive care unit was not significantly different between the groups but t
7、he FT approach led to an earlier hospital discharge with a median of 10 days.Endocrine and breast surgeryTwo cohort studies documented the implementation of FT principles in parathyroid surgery allowing discharge within 424 h 75, 76. Laparoscopic adrenalectomy has also been successfully performed wi
8、thin a FT program according to small consecutive series 77, 78. Hospital discharge was achieved within 324 h. One cohort study (n0292) imple- mented a FT pathway to optimize the economic viability of thyroid surgery 79. Included FT interventions were patient education, avoidance of neck drains, disc
9、ontinuation of intravenous fluids, ambulation, and oral feeding starting on the evening of the operation. The majority of patients were discharged on the first postoperative day in addition to lowering of overall costs. Two consecutive series reported mastectomy in a FT setting 80, 81. Hospital stay
10、 was less than 1 day. Notably, paravertebral blocks were associated with a reduction in PONVand postoperative pain and led to earlier recovery 80.Pediatric surgeryTwo cohort studies investigated the role of FT surgery in pediatricsurgeryincludingabdominal,thoracic,andurological procedures 82, 83. Th
11、e FT protocol included preoperativeeducation, minimally invasive techniques (selectively), oral nutrition, and mobilization starting 2 h postoperatively and no use of drains, tubes, and catheters. Pain treatment consisted of caudal block, nonsteroidal antiinflammatory drugs, and patient-controlled a
12、nalgesia. FT surgery was feasible in 3070 % depending on the type of surgical procedure being performed. Mean hospital stay was signifi- cantly reduced when compared to national diagnosis-related group data. Other cohort studies have shown the feasibility of the FT approach in laparoscopic appendect
13、omy 84 and colectomy 85 allowing discharge within 24 h and 4 days, respectively.DiscussionThis article has provided an overview of the current evi- dence for FT methodology in a range of surgical procedures. The concept of FT rehabilitation is now established as safe and effective. Patients treated
14、according to FT principles can expect a faster recovery without increased adverse events. Other benefits of the FT approach include a reduction in complications, ileus, fatigue, pain, and hospital expenses. However, despite clear benefits of FT care, implementation in daily practice has been slow. S
15、everal cross-sectional surveys have documented that perioperative care is still traditional in many institutions 8694. FTsurgery requires organizational changes within the hospital, and can, there- fore, be difficult to achieve. The increased translation of FT methodology into routine clinical pract
16、ice is dependent on multidisciplinary collaborations and discussions, monitoring of own results against national and international levels, identification of culture barriers, and education and leader- ship from doctors and nurses 95, 96. The ERAS society, with roots in the ERAS study group 16, was instituted in 2010 to improve perioperative management through the implementation of evidence-based practice. In Germany, the introduction of FT surgery in select
