TY - JOUR
T1 - A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery
AU - Nygren, J.
AU - Hausel, J.
AU - Kehlet, H.
AU - Revhaug, A.
AU - Lassen, K.
AU - Dejong, C.H.
AU - Andersen, J.
AU - von Meyenfeldt, M.F.
AU - Ljungqvist, O.
AU - Fearon, K.C.
PY - 2005/1/1
Y1 - 2005/1/1
N2 - BACKGROUND & AIMS: This study reviewed the case mix, clinical management, and clinical outcomes of patients undergoing colorectal resection in five European centres performing different forms of conventional or 'fast-track' perioperative care. METHODS: The perioperative care programme and surgical practice in each centre was defined. Patient data were collected by case-note review on an internet-based audit system. Case mix was determined using ASA classification and the P-POSSUM scoring system. RESULTS: A total of 451 consecutive patients from units practicing either conventional (Sweden, n=109; UK, n=87; Netherlands, n=76, Norway, n=61) or fast-track surgery (Denmark, n=118), were studied between 1998 and 2001. Elements of perioperative practice varied widely both between units practicing 'traditional' care and the reference 'fast-track' unit (Denmark). Based on the P-POSSUM scores, the case mix was similar between centres. There were no differences in morbidity or 30-day mortality between the different centres. The median length of stay was 2 days in Denmark and 7-9 days in the other centres (P<0.05). The readmission rate was 22% in Denmark and 2-16% in the other centres (P<0.05). CONCLUSION: Compared with traditional care, fast-track perioperative care results in a reduced length of hospital stay but may be associated with a higher readmission rate. Morbidity and mortality appears to be similar with either approach. Prospective evaluation of the potential benefits of the fast-track approach in different European centres is merited.
AB - BACKGROUND & AIMS: This study reviewed the case mix, clinical management, and clinical outcomes of patients undergoing colorectal resection in five European centres performing different forms of conventional or 'fast-track' perioperative care. METHODS: The perioperative care programme and surgical practice in each centre was defined. Patient data were collected by case-note review on an internet-based audit system. Case mix was determined using ASA classification and the P-POSSUM scoring system. RESULTS: A total of 451 consecutive patients from units practicing either conventional (Sweden, n=109; UK, n=87; Netherlands, n=76, Norway, n=61) or fast-track surgery (Denmark, n=118), were studied between 1998 and 2001. Elements of perioperative practice varied widely both between units practicing 'traditional' care and the reference 'fast-track' unit (Denmark). Based on the P-POSSUM scores, the case mix was similar between centres. There were no differences in morbidity or 30-day mortality between the different centres. The median length of stay was 2 days in Denmark and 7-9 days in the other centres (P<0.05). The readmission rate was 22% in Denmark and 2-16% in the other centres (P<0.05). CONCLUSION: Compared with traditional care, fast-track perioperative care results in a reduced length of hospital stay but may be associated with a higher readmission rate. Morbidity and mortality appears to be similar with either approach. Prospective evaluation of the potential benefits of the fast-track approach in different European centres is merited.
U2 - 10.1016/j.clnu.2005.02.003
DO - 10.1016/j.clnu.2005.02.003
M3 - Article
C2 - 15896433
SN - 0261-5614
VL - 24
SP - 455
EP - 461
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 3
ER -