Fast-Track-Chirurgie - Voraussetzungen und Herausforderungen in der Nachbehandlung

Abstract

In the last 15 years the Fast Track Concept or Enhanced Recovery after Surgery (ERAS) as a clinical pathway for improving perioperative care, maintaining physiological functions, reducing intraoperative stress and shortening the length of hospital stay, has become more common in colorectal surgery. After first promising results in prospective studies an expert group developed recommendations of a modified, multimodal Fast Track Concept in 2009. Main elements in this concept are laparoscopy, no nasogastric tubes, perioperative peridural anaesthesia and quick mobilisation of the patient after surgery. A metaanalysis in 2011 based on the Cochrane database showed, that in most studies regarding Fast Track Surgery, the authors have not strictly followed the recommendations of the expert group. Further studies with better quality and strict adaption on the multimodal principles of Fast Track Surgery are needed to gain more evidence. Furthermore the Fast Track Concept constitutes a challenge for the interdisciplinary collaboration of all involved treatment groups. Especially the postoperative outpatient treatment remains a problem due to unavailable rehabilitation capacities or ambulant care. Therefore a proper preoperative planning of the Fast Track Concept and the outpatient care should be performed interdisciplinary by the surgeons and the general practitioners.