A Comparative Study of ‘Fast-Track’ Versus Traditional Peri-Operative Care Protocols in Gastrointestinal Surgeries A fast-track program reduces complications and length of hospital stay after open colonic surgery. Implementing Fast-Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial Fast-track surgery improves postoperative clinical recovery and reduces postoperative insulin resistance after esophagectomy for esophageal cancer ‘Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation Fast Track Postoperative Management after Elective Colorectal Surgery: A Controlled Trail Safety and Efficacy of Fast-track Surgery in Laparoscopic Distal Gastrectomy for Gastric Cancer: A Randomized Clinical Trial Fast-track surgery in laparoscopic radical prostatectomy: basic principles Fast-Track Surgery Improves Postoperative Clinical Recovery and Immunity After Elective Surgery for Colorectal Carcinoma: Randomized Controlled Clinical Trial Fast-track Surgery Improves Postoperative Recovery in Patients with Gastric Cancer: A Randomized Comparison with Conventional Postoperative Care Fast-track in open intestinal surgery: prospective randomized study (Clinical Trials Gov Identifier no. NCT00123456). Impact of a fast‐track surgery programme for pancreaticoduodenectomy The future of fast‐track surgery Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery. Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection Fast-Track Versus Standard Care in Laparoscopic High Anterior Resection: A Prospective Randomized-Controlled Trial Impact of fast-track postoperative care on intestinal function, pain, and length of hospital stay after laparoscopic radical prostatectomy.
Introduction A ‘ fast-track protocol ’ in surgery suggests the application of evidence -based practice s to expedite patient recovery . It has shown to reduce hospital stay , hasten recovery as well as facilitate earlier return to work . It has a considerable impact in reducing healthcare costs . The basic tenet is to treat the patient ’s disease by minimal disturbance of their physiology . The protocol encompasses pre-operative , intra-operative and post-operative interventions which when carried out together would show maximal benefits . The surgeon is usually the leader of the team managing the patient , but it can not be over-emphasised that this is a multi-disciplinary team approach . Material s and Methods We conducted a prospect i ve interventional study to investigate whether ‘ fast-track ’ surgery protocol s improve patient outcome when compared to traditional peri-operative care followed at our institute . By doing so , we observed that the patients who underwent ‘ fast tracking ’  required lesser analgesia , had earlier ambulation , earlier return of intestinal motility , were free from tubes , catheters and drains earlier and lastly were discharged earlier . This was achieved without a rise in complications or re-admissions . Results / Conclusion The results have proved that implementing the fast-track protocol for gastrointestinal surgeries is not only safe and effective , but also improves patient outcome BACKGROUND & AIMS A fast-track program is a multimodal approach for patients undergoing colonic surgery that combines stringent regimens of perioperative care ( fluid restriction , optimized analgesia , forced mobilization , and early oral feeding ) to reduce perioperative morbidity , hospital stay , and cost . We investigated the impact of a fast-track protocol on postoperative morbidity in patients after open colonic surgery . METHODS A r and omized trial of patients in 4 teaching hospitals in Switzerl and included 156 patients undergoing elective open colonic surgery who were assigned to either a fast-track program or st and ard care . The primary end point was the 30-day complication rate . Secondary end points were severity of complications , hospital stay , and compliance with the fast-track protocol . RESULTS The fast-track protocol significantly decreased the number of complications ( 16 of 76 in the fast-track group vs 37 of 75 in the st and ard care group ; P = .0014 ) , result ing in shorter hospital stays ( median , 5 days ; range , 2 - 30 vs 9 days , respectively ; range , 6 - 30 ; P < .0001 ) . There was a trend toward less severe complications in the fast-track group . A multiple logistic regression analysis revealed fluid administration greater than the restriction limits ( odds ratio , 4.198 ; 95 % confidence interval , 1.7 - 10.366 ; P = .002 ) and a nonfunctioning epidural analgesia ( odds ratio , 3.365 ; 95 % confidence interval , 1.367 - 8.283 ; P = .008 ) as independent predictors of postoperative complications . CONCLUSIONS The fast-track program reduces the rate of postoperative complications and length of hospital stay and should be considered as st and ard care . Fluid restriction and an effective epidural analgesia are the key factors that determine outcome of the fast-track program Background Fast-track protocol s are followed by an enhanced recovery , early return to bowel function and to complete nutrition , and a reduced hospital stay . Our study was design ed to implement fast-track protocol in our university hospital . Methods The 96 consecutive patients with colorectal neoplasm included in the study were r and omized in two equal groups : group 1 ( FT ) included patients undergoing colorectal surgery in a fast-track protocol , and group 2 ( C ) included patients undergoing colorectal surgery with a conventional care protocol .  As with other fast-track protocol s , our protocol included carbohydrate fluids load before operation , early mobilization and oral feeding , regular prokinetics , and multimodal postoperative analgesia .  Time to restoration of bowel function , to complete mobilization and feeding , length of hospital stay , and incidence of complications and readmissions were monitored . Results Time to mobilization , restoring of bowel function , and complete oral feeding were significantly shorter with fast-track protocol ( p = 0.001 , p = 0.042 , and p = 0.01 , respectively ) . Hospital stay also was shorter in the fast-track group ( p = 0.001 ) . The incidence of complications did not significantly differ with the study groups . Conclusions In our study , fast-track protocol result ed in a shorter time to mobilization , complete feeding , and discharge from hospital . Fast-track protocol did not increase the incidence of complications . However , we consider that our data require further confirmation with powered multicenter national studies Purpose This study aims to investigate the influence of fast-track surgery ( FTS ) on insulin resistance indicators in a prospect i ve r and omized , controlled clinical trial in esophageal cancer patients . Methods Between November 2009 and March 2011 , 34 patients underwent the FTS pathway , and 34 patients underwent the conventional pathway after esophagectomy in our department . The times to postoperative flatus and defecation , duration of postoperative hospital stay , hospitalization expenditures , and postoperative complications were recorded . Insulin resistance indicators were measured before operation as well as on the 1st , 3rd , and 7th postoperative days ( PODs ) , including serum levels of fasting blood glucose ( FBG ) , fasting insulin ( FINS ) , interleukin-6 ( IL-6 ) , and C-reactive protein ( CRP ) in patients of both groups . The insulin resistance index ( homeostasis model assessment of insulin resistance ( HOMA-IR ) ) was calculated at each time point . Results We found a significantly shorter postoperative hospital stay and faster return of gastrointestinal function in patients who underwent  FTS  ( P < 0.01 ) . In addition , the total hospitalization expenditure was significantly lower in the FTS group ( P < 0.01 ) . The preoperative insulin resistance indicators showed no significant differences between the two groups . On PODs 1 and 3 , the levels of log-HOMA-IR , FINS , IL-6 , and CRP in the FTS group were significantly lower than those in the control group ( all P < 0.05 ) . On POD 7 , the CRP level in the FTS group was significantly lower than that in the control group ( P < 0.05 ) . Conclusions FTS promotes early recovery of gastrointestinal function and reduces stress reaction and postoperative insulin resistance after esophagectomy for esophageal cancer Background  Laparoscopic colorectal resection improves patient outcome by reducing pain , postoperative pulmonary dysfunction , gastrointestinal paralysis , and fatigue . A multimodal rehabilitation program ( “ fast-track ” ) with epidural analgesia , early oral feeding , and enforced mobilization may further improve the excellent results of laparoscopic colorectal resection , enabling early ambulation of these patients . Methods Fifty two consecutive patients underwent laparoscopic sigmoidectomy with st and ardized regular perioperative treatment ( st and ard ) or multimodal rehabilitation program ( “ fast-track ” ) .  Outcome measures included pulmonary function , duration of postoperative ileus , pain perception , fatigue , morbidity , and mortality . Results Twenty nine st and ard-care patients ( 19 men and 10 women ) and 23 fast-track patients ( 15 men and eight women ) were evaluated . Demographic and operative data were similar for the two groups . On the 1st postoperative day , pulmonary function was improved ( p = 0.01 ) in fast-track patients . Oral feeding was achieved earlier ( p < 0.01 ) and defecation occurred earlier ( p < 0.01 ) in the fast-track group . Visual analogue scale scores for pain were similar for the two groups ( p > 0.05 ) , but fatigue was increased in the st and ard-care group on the 1st ( p = 0.06 ) and 2nd ( p < 0.05 ) postoperative days . Morbidity was not different for the two groups . Fast-track patients were discharged on day 4 ( range , 3–6 ) and st and ard-care patients on day 7 ( range , 4–14 ) ( p < 0.001 ) . Conclusion Multimodal rehabiliation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay In the attempt to reduce postoperative complications and costs and improve outcomes , the concept of fast track surgery has been proposed . Improvements in anesthesia techniques and a better underst and ing of the pathophysiologic events occurring during and after surgery have made it possible . A group of patients undergoing colorectal resections with a fast track approach were investigated ; specifically , the effects on postoperative morbidity , resumption of intestinal function , and duration of hospitalization .  Fifty patients were managed according to a protocol , which included epidural analgesia , early ambulation , and oral feeding ( fast track group ) ;  they were compared with 50 patients managed with a different protocol : no epidural analgesia , early ambulation , and early oral diet ( control group ) . Primary outcome end-points reported include morbidity , time to passage of flatus and stool , and length of hospital stay . Fourteen complications occurred in the fast track group and 13 in the control group ( P = not significant ( NS ) ) . Resumption of intestinal function occurred after 3 days , and length of hospital stay was 5 days in the fast track group compared with 4 and 7 days respectively in control patients ( P = NS , P < 0.01 ) . Patients undergoing elective colorectal resections can be managed safely with fast track protocol s reducing hospital stay Background Fast-track surgery has been shown to enhance postoperative recovery in several surgical fields . This study aim ed to evaluate the safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy . Methods The present study was design ed as a single-center , r and omized , unblinded , parallel-group trial . Patients were eligible if they had gastric cancer for which laparoscopic distal gastrectomy was indicated . The fast-track surgery protocol included intensive preoperative education , a short duration of fasting , a preoperative carbohydrate load , early postoperative ambulation , early feeding , and sufficient pain control using local anesthetics perfused via a local anesthesia pump device , with limited use of opioids . The primary endpoint was the duration of possible and actual postoperative hospital stay . Results We r and omized 47 patients into a fast-track group ( n = 22 ) and a conventional pathway group ( n = 22 ) , with three patients withdrawn . The possible and actual postoperative hospital stays were shorter in the fast-track group than in the conventional group ( 4.68 ± 0.65 vs. 7.05 ± 0.65 ; P < 0.001 and 5.36 ± 1.46 vs. 7.95 ± 1.98 ; P < 0.001 ) . The time to first flatus and pain intensity were not different between groups ; however , a greater frequency of additional pain control was needed in the conventional group ( 3.64 ± 3.66 vs. 1.64 ± 1.33 ; P = 0.023 ) . The fast-track group was superior to the conventional group in several factors of the European Organization for Research and Treatment of Cancer Quality of Life Question naire , including : fatigue , appetite loss , financial problems , and anxiety . The complication and readmission rates were similar between groups . Conclusions Fast-track surgery could enhance postoperative recovery , improve immediate postoperative quality of life , and be safely applied in laparoscopic distal gastrectomy Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase . The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer . Twenty-five patients each were r and omized in the study groups to verify if a fast-track regimen could be transferred into clinical routine . The perioperative data , early complications , hospital stay as well as readmission rate were analyzed . The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group . The overall complications were significantly less in the fast-track procedure . The readmission rate was low and not significant . Patients receiving an LRPE benefit from a suitable fast-track concept . The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate . Thus , fast-track concepts might contribute to saving re sources in the long term . However , more evidence based on larger prospect i ve trials is needed to achieve optimal quality of life for patients perioperatively Background Few clinical studies or r and omized clinical trial results have reported the impact of fast-track surgery on human immunity . This study aim ed to investigate the clinical and immune impact of fast-track surgery in colorectal cancer patients undergoing elective open surgery . Methods A controlled r and omized clinical trial was conducted from November 2008 to January 2009 with a 1-month postdischarge follow-up . A total of 70 patients with colorectal carcinoma requiring colorectal resection were r and omized into two groups : a fast-track group ( 35 cases ) and a conventional care group ( 35 cases ) . All included patients underwent elective open colorectal resection with combined tracheal intubation and general anesthesia .  Clinical parameters and markers of immune function were evaluated in both groups postoperatively . Results In all , 62 patients completed the study : 32 in the fast-track group and 30 in the conventional care group . Our findings revealed a significantly shorter postoperative hospital stay and faster return of gastrointestinal function in patients undergoing fast-track rehabilitation . In addition , we found a quicker response of white blood cells in the fast-track group than in the conventional care group . We also found that blood levels of globulin , immunoglobulin G , and complement 4 on postoperative day 3 were higher in the fast-track group than in the conventional care group . Conclusions Fast-track surgery accelerates clinical recovery and improves postoperative immunity after elective open surgery for colorectal carcinoma Background Fast-track surgery is a new , promising comprehensive program for surgical patients and is beneficial to recovery . Prospect i ve r and omized , controlled clinical trials involving fast-track surgery for gastric cancer are lacking . Patient and methods Ninety-two patients with gastric cancer were r and omly divided into a fast-track surgery group ( n = 45 ) and conventional surgery group ( n = 47 ) . We compared outcomes ( duration of postoperative stay in hospital , fever , and flatus , complications , and medical costs ) ; postoperative serum levels of tumor necrosis factor-α , interleukin-6 , and C-reactive protein ; and resting energy expenditure between two groups . Results Compared with the conventional surgery group , the fast-track surgery group had no more complications ( P > 0.05 ) with a significantly shorter duration of fever , flatus , and hospital stay , and less medical costs as well as a higher quality of life score on hospital discharge ( all P < 0.05 ) . With a significantly lower resting energy expenditure ( days 1 and 3 ) postoperatively ( P < 0.05 ) , the fast-track surgery group showed a lower serum level of tumor necrosis factor-α ( days 1 and 3 ) , interleukin-6 ( days 1 and 3 ) , and C-reactive protein ( days 1 , 3 , and 7 ) than the conventional surgery group ( all P < 0.05 ) . Conclusions Fast-track surgery can lessen postoperative stress reactions and accelerate rehabilitation for patients with gastric cancer BACKGROUND Studies have shown the value of using fast-track postoperative recovery . St and ard procedures ( non-fast-track strategies ) remain in common use for perioperative care . Few prospect i ve reports exist on the outcome of fast-tracking in Central Europe . The aim of our study was to assess the effect and safety of our own fast-track protocol with regard to the postoperative period after open bowel resection . PATIENTS AND METHODS One hundred and five patients with ASA score I-II scheduled for open intestinal resection in the period April 2005-December 2007 were r and omly selected for the fast-track group ( FT ) and non-fast-track group ( non-FT ) . A design ed protocol was used in the FT group with the emphasis on an interdisciplinary approach . The control group ( non-FT ) was treated by st and ard established procedures .  Postoperative pain , rehabilitation , gastrointestinal functions , postoperative complications , and post-op length of stay were recorded . RESULTS Of 105 patients , 103 were statistically analyzed . Patients in the FT group ( n=51 ) and non-FT group ( n=52 ) did not differ in age , surgical diagnosis , or procedure . The fast-track procedure led to significantly better control of postoperative pain and faster restoration of GI functions ( bowel movement after 1.3 days vs. 3.1 , p<0.001 ) . Food tolerance was significantly better in the FT group and rehabilitation was also faster . Hospital stay was shorter in the FT group - median seven days ( 95 % CI 7.0 - 7.7 ) versus ten days ( 95 % CI 9.5 - 11.3 ) in non-FT ( p<0.001 ) . Postoperative complications within 30 postoperative days were also significantly lower in the FT group ( 21.6 vs. 48.1 % , p=0.003 ) . There were no deaths and no patients were readmitted within 30 days . CONCLUSIONS Following the FT protocol helped to reduce frequency of postoperative complications and reduced hospital stay . We conclude that the FT strategy is safe and effective in improving postoperative outcomes Fast‐track ( FT ) programmes are multimodal , evidence ‐based approaches to optimize patient outcome after surgery . The aim of this study was to evaluate the safety , clinical outcome and patients ' experience of a FT programme after pancreaticoduodenectomy ( PD ) in a high‐volume institution in Sweden Since its introduction in the 1990s , the concept of multimodal perioperative care ( fast-track surgery , enhanced recovery programmes ) has gained widespread acceptance and is now considered as a st and ard of care . Most studies that support this approach relate to colorectal surgery , but similar data have been published across surgical specialties with major economic benefits 1–4 . The implementation process has been described in detail and is essentially based on the simple question : ‘ Why is the postoperative patient in hospital today?’1,5 . The relevant question may therefore be asked – what next ? Postoperative length of stay is often seen as the key outcome for fast-track surgery and , although this may not always be appropriate , whatever is used as a primary outcome measure must be justified adequately . It should also be emphasized that significant progress in fast-track care dem and s inclusion and implementation of all of its basic components . Many studies have not implemented the most important aspects of the care programmes that were originally described , including patient information , effective thoracic epidural analgesia with sufficient local anaesthetic that facilitates early mobilization , reduced ileus and rapid re introduction of oral feeding , or the use of non-opioid analgesia , where appropriate , in open or minimally invasive surgery . An important issue that needs to be addressed in future is detailed analysis of ‘ medical ’ versus ‘ surgical ’ morbidity6 . To improve further our underst and ing of perioperative risk , future studies must analyse how one specific complication might lead to another : for instance , whether a pneumonia or myocardial infa rct ion led to an anastomotic dehiscence ; or a wound dehiscence with reoperation led to a subsequent pneumonia , myocardial infa rct ion or thromboembolic complication6 . Initial ‘ medical ’ morbidity may depend on perioperative care principles and pre-existing comorbidity , in contrast to an initial ‘ surgical ’ complication , which may depend on surgical technique , and therefore require a different approach from fast-track methodology . How might the fast-track approach evolve further , as surgeons perform an ever-increasing number of major procedures in older patients with comorbidities , with greater risks of postoperative complications , prolonged hospital stay and death6 ? Preoperative evaluation of operative risk may not be helpful unless evidence -based perioperative interventions are available and instituted . Thus , the specific role of preoperative morbidity , such as smoking , diabetes and cardiopulmonary disease , in determining the risk of postoperative morbidity needs to be reassessed in studies with a fully implemented fast-track procedure-specific programme6 . We also need to have a second look at the relative roles of the different components of the fast-track programme ( for example type of analgesia and fluid management1,5 ) and analyse where progress can be made in order to reduce perioperative risk and morbidity , instead of focusing on length of stay as the primary outcome . The surgical stress response is proportional to the degree of insult and the main factor that contributes to postoperative organ dysfunction1,2 . Every effort should therefore be made to reduce those responses that are undesirable . Regional anaesthetic techniques have a powerful effect on the catabolic response , reducing cardiac dem and s , pain , pulmonary dysfunction and ileus .  Regional anaesthesia should be used whenever possible on a procedure-specific basis7 . Inflammatory responses contribute to pain , fatigue and organ dysfunction . They can be modified pharmacologically by preoperative glucocorticoids8 . Significant reductions in pain , nausea and vomiting , and early fatigue have been demonstrated , facilitating early recovery , so far without demonstrable side-effects . More procedure-specific and dosefinding studies are required . A single preoperative glucocorticoid dose in a larger amount than used for conventional nausea and vomiting prophylaxis might , for instance , be an important contributory factor to improving fast-track programmes in high-risk patients . Minimally invasive surgery also reduces the inflammatory response , although the contribution that this plays in the context of fast-track programmes in colonic surgery is difficult to interpret , as the care programmes used in the ‘ open ’ groups have often not been fully implemented6,9,10 . Therefore , future efforts to assess early postoperative outcome effects of minimally invasive surgery should include r and omized studies with fully implemented fasttrack programmes11 . Newer developments in minimally invasive BACKGROUND & AIMS Postoperative ileus is characterized by delayed gastrointestinal ( GI ) transit and is a major determinant of recovery after colorectal surgery . Both laparoscopic surgery and fast-track multimodal perioperative care have been reported to improve clinical recovery . However , objective measures supporting faster GI recovery are lacking . Therefore , GI transit was measured following open and laparoscopic colorectal surgery with or without fast-track care . METHODS Patients ( n = 93 ) requiring elective colonic surgery were r and omized to laparoscopic or conventional surgery with fast-track multimodal management or st and ard care  , result ing in 4 treatment arms . Gastric emptying and colonic transit were scintigraphically assessed from days 1 to 3 in 78 patients and compared with clinical parameters such as time to tolerance of solid food and /or bowel movement and time until ( ready for ) discharge . RESULTS A total of 71 patients without mechanical bowel obstructions or surgical complications requiring intervention were available for analysis . No differences in gastric emptying 24 hours after surgery between the different groups were observed ( P = .61 ) . However , the median colonic transit of patients undergoing laparoscopic/fast-track care was significantly faster compared with the laparoscopic/st and ard , open/fast-track , and open/st and ard care groups . Multiple linear regression analysis showed that both laparoscopic surgery and fast-track care were significant independent predictive factors of improved colonic transit . Both were associated with significantly faster clinical recovery and shorter time until tolerance of solid food and first bowel movement . CONCLUSIONS Colonic transit recovers significantly faster after laparoscopic surgery and the fast-track program ; laparoscopy and fast-track care lead to faster recovery of GI motility and improve clinical recovery A fast-track clinical pathway is design ed to streamline patient care delivery and maximize cost effectiveness . It has decreased postoperative length of stay ( LOS ) and hospital charges for many surgical procedures . However , data on clinical pathways after liver surgery are sparse . This study examined whether use of a fast-track clinical pathway for patients undergoing elective liver resection affected postoperative LOS and hospital charges . A fast-track clinical pathway was developed and implemented by a multidisciplinary team for patients undergoing liver resection . Between July , 2007 and May , 2008 , a total of 117 patients underwent elective liver resection :  the fast-track clinical pathway ( education of patients and families , earlier oral feeding , earlier discontinuation of intravenous fluid , no drains or nasogastric tubes , early ambulation , use of a urinary catheter for less than 24 h and planned discharge 6 days after surgery ) was studied prospect ively in 56 patients ( postpathway group ) . These patients were compared with the remainder who had usual care ( prepathway group ) . Outcome measures were postoperative LOS , perioperative hospital charges , intraoperative and postoperative complications , mortality , and readmission rate .  Among all patients , 69 ( 59 % ) had complicating diseases and /or a history of surgery and 24 patients belonged to American Society of Anesthesiologists grade III – IV . Compared with the prepathway group , the postpathway group had a significantly shorter postoperative LOS ( 7 vs. 11 days , P < 0.01 ) . The average perioperative hospital charges were RMB 26,626 for patients in the prepathway group and only RMB 21,004 for those in the postpathway group ( P < 0.05 ) , with no differences in intraoperative and postoperative complications ( P = 0.814 ) , mortality ( P = 0.606 ) , and readmission rate ( P = 0.424 ) . Implementation of the fast-track clinical pathway is an effective and safe method for reducing postoperative LOS and hospital charges for high-risk patients undergoing elective liver resection . The result supports the further development of fast-track clinical pathways for liver surgical procedures The value of fast-track ( FT ) multimodal recovery programs in improving hospitalization of surgical patients has been widely proved . The application of FT protocol s to laparoscopic colorectal surgery seems to maximize the effects of the minimally invasive approach . The objectives of this r and omized-controlled trial are to compare the short-term outcomes ( bowel function , return to oral nutrition , day of discharge , fatigue , time to resume normal activities , functional capabilities , and readmission rate ) of patients undergoing elective laparoscopic high anterior resection ( HAR ) following either a FT or a st and ard program . The prospect i ve r and omized-controlled trial included 52 consecutive patients undergoing elective laparoscopic HAR . Group 1 was treated with a FT rehabilitation program , and group 2 was treated with a st and ard care ( SC ) program . Patients were interviewed 14 and 30 days postoperatively . One patient in each group was excluded from the study . Mean hospital stay , time of first bowel movement , and bowel function resumption were significantly shorter in the FT group ( P<0.05 ) . Patients in the FT group referred more pain in day 0 versus patients in the SC group ( P<0.05 ) even though the difference disappeared from day 1 . Fatigue was significantly reduced at day 14 in the FT group compared with the SC group ( P<0.01 ) . Similarly , ability to resume the normal preoperative attitude ( walking stairs , cooking , housekeeping , shopping , and walking outdoors ) was significantly better at day 14 in the FT group ( P<0.005 ) . There was no significant difference between the 2 groups at day 30 for the same parameters . There were no readmissions in both the groups and no need for consultations from general practitioners . FT multimodal program is a safe approach effective on postoperative short-term outcome significantly reducing hospital stay . Early postoperative pain control needs to be optimized BACKGROUND AND PURPOSE Postoperative recovery of intestinal function , ability to ambulate , and effective pain management are main features to establish an effective fast-track surgery model . We investigated pain scores , ambulation rate , and recovery of intestinal function in a cohort of patients who were undergoing laparoscopic radical prostatectomy ( LRP ) .  PATIENTS AND METHODS Fifty patients who underwent LRP in our institution were r and omized to receive either  conventional  or  fast-track postoperative care . Postoperative intestinal function was quantified by clinical signs of intestinal motility . Ambulation data were collected by means of step-count devices . Pain scores were measured by a visual analog scale . Overall satisfaction and additional measures to describe patient satisfaction with the clinical course were used as quality -of-life variables . RESULTS Fast-track patients had significantly earlier propulsive intestinal motility without increased intestinal complications . Enforced mobilization led to a significantly shorter period to first deflation/defecation . Despite significantly increased ambulation rates in the fast-track group , these patients reported significantly less pain sentience during a significantly shorter hospital stay . Overall satisfaction was significantly higher in the fast-track cohort during the hospital stay . CONCLUSION With the implementation of fast-track concepts for LRP , patients can be discharged to home earlier with fewer complications , lower pain scores , and an overall higher satisfaction with life
A pattern of consistent evolution in fast-track protocol s was clearly demonstrated and these have shown variations in the core-identified components across the studies .
In the future incremental gains through focused improvements in key components will lend itself to even better postoperative outcomes and patient experience during oesophageal cancer treatment
Fast track is a st and ardised goal directed patient 's care pathway that aims to facilitate recovery following surgery .
Currently , there are large variations in the fast track protocol s used in oesophagectomy due to the complexity of the procedure .
The objective of this systematic review is to assess the evolution of fast track protocol s  following oesophagectomy  since its implementation and the result ing effect on postoperative outcomes .