“Fast track rehabilitation is a concept that involves surgery, anaesthesia and nursing care. The patient is guided quickly through his operation. The normal body functions like breathing, eating and drinking are deactivated only for a short time if at all and the treated person is mobilized as quickly as possible”, summarises Prof. Dr. Thomas Standl, head physician of the Centre of Anaesthesiology and Intensive Care Medicine of the City Hospital Solingen the procedure. His ward has been using the concept since approximately a year – with good results.
The patients in Solingen are allowed to drink until two hours before the surgery. They are already allowed to eat two yoghurts the evening after the operation. In the past, surgeons were afraid to burden the freshly operated intestine. Therefore, patients received total parenteral nutrition after a colon operation. “Meanwhile it has been observed that it does more harm than good to the intestine when it is drained for days”, says Standl.
The operation itself is minimally invasive, as far as this is possible. During surgery a pain catheter is installed close to the spinal cord. Thus the patient has no pain after the procedure and he does not suffer from side effects due to intravenous painkillers. “From the opioides the medicated people get tired, the intestine is slow”, tells Standl. With the epidural anaesthesia, which operates only locally, the patient can get up during the first day. “The patient is first mobilised into a chair for a couple of hours. In the evening he can even go for a short stroll on the ward corridor”, says Standl.
In the Charité in Berlin, Germany, the concept was employed five years ago. “With fast track we have cut the rate of general complications like pneumonia or thrombosis in half, from 20 to nine percent”, says Prof. Dr. Wolfgang Schwenk from the Department of General, Visceral, Vascular and Thoracic Surgery of the Charité. The complications are typical epiphenomenons when people are bedridden. “By now we discharge most patients after five days. The average length of stay in Germany adds up to two weeks. The readmission rate is not higher than when using the conventional procedure.” Fast track is also used for lung and prostate operations.
Both physicians emphasize how important the interdisciplinary cooperation between surgeons, anaesthetists and nurses is. “The surgeon can do fast track as long as he likes, he is not going to be successful if the anaesthetist does not participate”, says Schwenk. “Without cooperation this will not work.”
Furthermore the patient plays an important part as well. “Even the best operation and anaesthetic is not going to work if the patient stays in bed for two days”, says the physician from Solingen Standl. The patient has to be informed in detail before the operation what he is supposed to do in order to receive the best possible outcome. To get the freshly operated people out of bed is not always an easy task, says Standl: “Some patients have unconsciously the attitude: I am ill, therefore I have to stay in bed. A lot of convincing is then necessary.”
Reducing the time of staying in hospital by 60 percent sounds tantalising to hospital managers. But: “At the moment many hospitals are interested in fast track, because they think they can reduce costs when the patient leaves the hospital earlier”, says Schwenk. “I am not so sure about this. A considerable amount of money has to be invested first, for example, into more employees and into pain therapy. The new concept is, however, not going to cost more money than the traditional one.”
Prof. Dr. Standl will give a lecture about “Fast-Track-Anaesthesia and Surgery” in German during MEDICA on 17th November at 2:30 pm in CCD.Süd, room 14.