Department Colorectal Surgery  ZARAGOZA UNIVERSITY HOSPITAL. SPAIN MULTICENTER NATIONAL STUDY  ON FAST TRACK COLORECTAL SU...
Department Colorectal Surgery (1993) Protocol for Colorectal Cancer   1998 Up-dated (Laparoscopic surgery):  2001 2004 200...
Department Colorectal Surgery (1993) Protocol for Colorectal Cancer   1998 Up-dated (Laparoscopic surgery):  2001 2004 200...
<ul><li>FAST-TRACK SURGERY : </li></ul><ul><li>Structured pathway </li></ul>Surgical stress reduction Pain relief Fluid th...
Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery Henrik Kehlet, Douglas W. Wilmore. Ann Surg  2008;248...
12 Centres Control Group: Retrospective Study (Six months) Prospective Study: Intention to treat Inclusion criteria:  Colo...
According to the Best available evidence we will: <ul><li>Avoid Bowel preparation </li></ul><ul><li>Avoid Drains </li></ul...
ON LINE. RECORDING DATA SYSTEM
RESULTS From July 2008 to April 2009
Retrospective Study  182 patients Mean age 69,6 y.o.  ± SD. 13,2 (43-89). Males 61%. 69% 31% Vía abordaje 69% 31% Surgical...
Overall: 34,82% Retrospective Study Mean Stay: 13 days  ± SD. 13,731 (4-40)  Postoperative morbidity 182 patients Mean age...
Early results (135 patients) Prospective Study Mean age 63,4 y.o.  ± SD. 10,2 (38-89). Males 60%. Surgical technique
<ul><li>Mean Stay: 7 days  (3-45)  </li></ul>Prospective Study Overall: 32 %
Prospective Retrospect. Laparosc.  Lap.   vs   Open surgery:   63   p.   vs   72 p.   (non stat. Diff.) Results
<ul><li>Preliminary results </li></ul><ul><li>Fast Track Spanish Program shorten Hospital Stay by 6 days, without increasi...
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MULTICENTER NATIONAL STUDY ON FAST TRACK COLORECTAL SURGERY. PRELIMINARY RESULTS.

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Transcript of "MULTICENTER NATIONAL STUDY ON FAST TRACK COLORECTAL SURGERY. PRELIMINARY RESULTS."

  1. 1. Department Colorectal Surgery ZARAGOZA UNIVERSITY HOSPITAL. SPAIN MULTICENTER NATIONAL STUDY ON FAST TRACK COLORECTAL SURGERY. PRELIMINARY RESULTS . JM Ramirez, JA Gracia, P Royo, E Casal-Nuñez, JV Roig, R Cabezali   on behalf of the Spanish working group on fast-track Surgery.
  2. 2. Department Colorectal Surgery (1993) Protocol for Colorectal Cancer 1998 Up-dated (Laparoscopic surgery): 2001 2004 2006 2.006: 141 patients (Mean age 69 (43-89))
  3. 3. Department Colorectal Surgery (1993) Protocol for Colorectal Cancer 1998 Up-dated (Laparoscopic surgery): 2001 2004 2006 2.006: 141 patients (Mean age 69 (43-89)) *NBCAP (21.356 cases) * National Bowel Cancer Audit Project. ACPGBI. Report 2007 10 29,6 4% Length Hospital stay (mean days) Permanent Stoma rate (PSR) Post-op. Mortality (<30 days) <12 28,3 <5%
  4. 4. <ul><li>FAST-TRACK SURGERY : </li></ul><ul><li>Structured pathway </li></ul>Surgical stress reduction Pain relief Fluid therapy Perioperative surgical care (drains, NGT, Bowel clearance, catheters = Hospital stay Morbidity Mortality
  5. 5. Evidence-Based Surgical Care and the Evolution of Fast-Track Surgery Henrik Kehlet, Douglas W. Wilmore. Ann Surg 2008;248: 189–198
  6. 6. 12 Centres Control Group: Retrospective Study (Six months) Prospective Study: Intention to treat Inclusion criteria: Colorectal cancer Open or Laparocopy Older than 18 y.o. Exclusion criteria: ASA IV Ostomy Previous CRT Madrid, April 2008
  7. 7. According to the Best available evidence we will: <ul><li>Avoid Bowel preparation </li></ul><ul><li>Avoid Drains </li></ul><ul><li>Avoid NGT </li></ul><ul><li>Use laparoscopy as much as posible </li></ul><ul><li>Use transverse incisions </li></ul><ul><li>Use Epidural anaesthesia (open surgery) </li></ul><ul><li>Use Warm sheet </li></ul><ul><li>Use High Oxigenation </li></ul><ul><li>Have special care in fluid management </li></ul><ul><li>CardioQ is mandatory </li></ul><ul><li>Give early oral intake </li></ul><ul><li>Press for early ambulation </li></ul>Madrid, April 2008
  8. 8. ON LINE. RECORDING DATA SYSTEM
  9. 9. RESULTS From July 2008 to April 2009
  10. 10. Retrospective Study 182 patients Mean age 69,6 y.o. ± SD. 13,2 (43-89). Males 61%. 69% 31% Vía abordaje 69% 31% Surgical technique Right colectomy Left Colectomy AR Sigmoidectomy approach Open surgery Lap. Surgery
  11. 11. Overall: 34,82% Retrospective Study Mean Stay: 13 days ± SD. 13,731 (4-40) Postoperative morbidity 182 patients Mean age 69,6 y.o. ± SD. 13,2 (43-89). Males 61%. W. Infection Bleeding Death ileus anastomotic leak
  12. 12. Early results (135 patients) Prospective Study Mean age 63,4 y.o. ± SD. 10,2 (38-89). Males 60%. Surgical technique
  13. 13. <ul><li>Mean Stay: 7 days (3-45) </li></ul>Prospective Study Overall: 32 %
  14. 14. Prospective Retrospect. Laparosc. Lap. vs Open surgery: 63 p. vs 72 p. (non stat. Diff.) Results
  15. 15. <ul><li>Preliminary results </li></ul><ul><li>Fast Track Spanish Program shorten Hospital Stay by 6 days, without increasing neither morbidity nor mortality </li></ul><ul><li>At the moment, we have not found differences between open and laparoscopic surgery withina fast track protocol. </li></ul>Summary

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