Fast track in colo-rectal surgery. Preliminary experience in a rural hospital

Background. "Fast Track surgery" is a therapeutic program of large application, despite some doubts about its applicability and real validity. Literature review shows that this approach to colo-rectal surgery, particularly video-assisted, can allow a rapid recovery, better performance and a faster postoperative functional autonomy of the work, which can be discharged without cause additional welfare costs; in addition it can be reproducible in different health reality. Purpose: To analyze the possibility to apply the Fast Truck protocol in patients undergoing colorectal surgery in a rural hospital and non specialistic Unit of Surgery. Patients and methods. We have conducted a prospective, randomized study on 80 patients subjected to colorectal surgery in the last year. Results: The protocol was observed in 95% of cases, compliance with the Fast Track was high and general morbidity was limited (7.8%). Conclusion. This "aggressive" approach, which has fundamentally altered the usual surgical behavior, seems to allow a mean length of stay significantly lower than in controls (p < 0.05) with positive implications for patients and containment of health care costs, even after discharge (no need for home care in 92% of cases, no early re-admittance to the hospital). Homogeneous protocols are desirable, as well as an increased enrollment, to consolidate these rehabilitation programs in order to provide a reference for all hospitals.