Fast-Track-Adhärenz bei traditionellem perioperativem Management elektiver kolorektaler Resektionen in deutschen Kliniken

Multimodal perioperative management pathways (mPOM) are recognized worldwide as the treatment of choice for elective colorectal resection under the terms enhanced recovery or fast-track surgery. Surveys in surgery and anesthesia in Germany and Austria indicated a relatively high degree of fast-track implementation for elective colorectal resection. This manuscript is the first to present detailed data on the actual use of fast-track elements prior to the structured implementation of a fast-track protocol in German hospitals.

The data of patients with elective colorectal resection were prospectively collected in a preparation phase. The participating hospitals developed their subsequent fast-track treatment pathway but did not change the previously carried out traditional perioperative treatment.

The data of 362 patients from 15 hospitals were collected. The majority of the patients (median age of 67.5 years) underwent surgery for colorectal carcinoma (59.1%), diverticular disease (16.8%) or chronic inflammatory bowel disease (11.1%). Adherence to 23 internationally recommended fast-track elements was overall 52%. The adherence to the intraoperative elements was 71% and therefore higher than adherence to the preoperative (55%) and postoperative (29%) fast-track elements. Complications occurred in 96 (26.5%) patients.

Adherence to the internationally recommended ERAS or fast-track elements was very low at 52% compared to the information provided in surveys. In surgery and anesthesiology the adherence to the measures tended to be overestimated, with deficits mainly in preoperative and postoperative management.