Fast-track Colorectal Surgery in China—3 years’ Experience


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Fast-track Colorectal Surgery in China—3 years’ Experience

  1. 1. Fast- Fast-track Colorectal Surgery in China—3 years’ Experience China— y p Anal colorectal Surgery Anal­colorectal Surgery West China Hospital of Sichuan University, China Li Li Ph.D. M.D.   Wang Xiaodong M.D. Li Li Ph D  M D    Wang Xiaodong M D
  2. 2. The Seed of FT Conception  Following the foreign papers in 2001~2005 2007 Two important reviews  published The Fast­Track Programmes of Multi­Disciplinary Treatment in Colorectal Surgery.  Th F t T k P f M lti Di i li T t ti C l t lS Chin J Bases Clin General Surg , 2007, 14(2): 239­242 (Liu Z, Wang XD, Li L) FOCUS ON Clinical Management Strategy Cli i l M t St t Nutrition and Fast Track Surgery. d k Parenteral & Enteral Nutrition, 2007, 14(2): 65­67 (Li JS) FOCUS ON Post­operation Rehabilitation in Nutrition
  3. 3. The Spread of FT Conception  Published papers in 2007~2009 the centers with FT studies ongoing (Papers) 20 15 11 10 4 1 5 7 7 4 0 (Year) 2007 2008 2009 Review Original Article
  4. 4. The Characteristics in Current Studies  53% published papers in Secondary literature  The papers from retrospect studies mainly p p p y  Small samples in studies  Similar studies based on some foreign papers Si il di b d f i  The studies for colon surgery more than rectal surgery  Adopt rules reported in foreign papers  Less studies for links in FT management Less studies for links in FT management  Lack the details in particular target from FT clinic
  5. 5. The Rethink from Chinese Experiences  West China Hospital of Sichuan University West China Hospital of Sichuan University  The biggest hospital in China  More than 800 cases colorectal operations per year More than 800 cases colorectal operations per year  Started FT management since 2005  More than 1,000 cases following FT management  Evidence based Medical Center of China Evidence based Medical Center of China   MDT work group in Anal‐colorectal Surgery
  6. 6. Building up FT Guideline  Single center  Evidence level in III IV Evidence level in III~IV grades Fast Track Guideline for Colorectal Surgery of  West China Hospital in Sichuan University  Published in 2009  Chin J Bases Clin General Surg, 16, (5­8)
  7. 7. FT Guideline in Single Center  Points in Pre­operation  Introduction FT management to patients Selection: •Admission •Operative preparation  Simplifying Intestinal Preparation p y g p Selection: •By oral intestinal cleaner 12h preop. •Drink water or tea till 6h preop. •Intestinal Obstruction included in FT
  8. 8.  Points in Intro­operation  Anaesthesia Selection: •Recommend continuous epidural anesthesia •Enough dose in first injection if chosen general anesthesia  Operation S l i Selection: •Best choice in mini‐incision laparotomy •Recommend laparoscopic resection Si lif i d t d d d i ti •Simplifying and standard procedure in operation •Short time and less bleeding
  9. 9.  Points in Post­operation p  Nursing and Education  Rehabilitation strategy gy Selection: •Fluid restriction: decreasing total volume to 500ml in 3 days •Nasogastric tube: without or keeping in 1 day •Drainage tube: without or keeping in 1 day •Urinary catheter: keeping in 1~3 days E l ti iti 24h t •Early activities: 24h postop. •Early oral feeding: water or tea 24h postop. and common diet 48h postop. •Regular pain‐control •Strengthen anti infection •Strengthen anti‐infection •Anti‐inflammatory response by hormone •Treatment in accelerating intestinal motility by drugs •Protection the quality in sleeping •Protection the quality in sleeping
  10. 10.  Restrict rules in discharge  Normal in vital sign  No feature in incision infection and abdominal signs g  Tolerance general diet  Basic activities in wards  Acceptable anal exsufflation or defecation  Independent urination  p OUTCOMES HIGHLIGHTS Until to OCT 2009: Discoveries: •Operative related re admission 0 8% •Operative related re‐admission 0.8% •Cured pts. with severe complications successfully •Total morbidity post‐op. 17.2% •Operative related mortality <0.5% •Cured pts. with intestinal obstruction successfully
  11. 11. Advanced FT researches  Series Prospective researches  Single center to multi centers Single center to multi‐centers Fast track programme  k in Colorectal Cancer Surgery  Supported by  2009 Science Research Projects in Health Department of Sichuan (NO. 090353)  FT related RCTs are registering
  12. 12. The difficulties of FT in China  Culture  Accept observation for long time in hospital  Require “no complications” in clinic  Economy  Fee afforded by insurance based on in‐hospital days  Clinic Cli i  Incomplete healthy services in communities  Collaboration in multi‐disciplinary influence  progression
  13. 13. The Future of FT in China  Cooperation with centers from Europe h f  Construction of Chinese FT network  Reform in details of FT with Chinese conditions
  14. 14. Welcome to China ! Welcome to hometown of Panda—Sichuan ! Contact to: Dr. Wang Xiaodong  86-28-138-8226-7388 