Implementing a fast-track protocol for patients undergoing bowel resection: not so fast.

BACKGROUND: Multimodality fast-track protocols have been shown to enhance recovery after bowel resection. However, it remains unclear which of the components impact outcomes and whether processes actually occur as intended.

METHODS: Consecutive patients who underwent elective bowel resection at a university teaching hospital under a standardized fast-track recovery protocol were compared with patients who underwent similar procedures before protocol initiation. Compliance was measured with the 7 major elements of the protocol: administration of nonopioid analgesia, perioperative lidocaine, nasogastric tube removal, early feeding, early ambulation, and fluid restriction.

RESULTS: Eighty pathway patients were compared with 87 conventional patients. Only 3 of the 7 major components were successfully implemented. Fluid restriction was achieved in only 2 patients. Pain scores and ileus-related morbidities were comparable with the exception of nasogastric tube reinsertion, which was required twice as often in pathway patients (17 vs 8, P = .02). Thirteen pathway patients were readmitted compared with 7 control patients (P = .11).

CONCLUSIONS: The delivery of expected care cannot be assumed. There was no discernible benefit in patient outcomes.