Fast track surgery versus conventional recovery strategies for colorectal surgery

Conventionally, recuperation after bowel surgery followed the patients progress. Mobilisation and expansion of diet after surgery was progressed slowly in a stepwise manner following patients progression. This is because it was believed that faster recovery would be unwise. In recent years, however, a new concept has been introduced, called Enhanced Recovery after surgery (ERAS) or fast track. This program, introduced by Kehlet et al, is based on the principle that reducing the body's stress response after surgery reduces the time needed to recuperate. This is achieved by interventions around the operation, involving good information, better feeding before the operation and better pain treatment, so patients can get out of bed earlier and start a normal diet earlier and thereby reducing the risk of complications. This review investigated whether this intervention is safe and whether it is more effective than the traditional treatment. In order to answer this question, 4 randomised trials were found, comparing these two interventions. We found that ERAS can be viewed as safe, i.e. not resulting in more complications or deaths, and at the same time decreases the days spent in hospital following major bowel surgery. However, the data are of low quality and therefore does not justify implementation of ERAS as the standard method of care yet. More research on other outcome parameters like economical evaluation and quality of life parameters are necessary.