Moynihan 04

Abstract

Aims: To investigate the effects of a multimodal rehabilitation package on physical, psychological and clinical outcome in patients after bowel resection compared with a traditional postoperative regimen. Methods: Patients requiring elective right and left hemicolectomy were randomized to receive the ‘optimization package’ (see Table) or the standard hospital pre‐ and postoperative regimen. Outcome measures of physical function were recorded preoperatively and on days 1, 7 and 30. Results: Twenty‐three patients were randomized, 13 to optimization with 10 controls. The groups were similar in terms of age (62 years versus 69 years), sex (M:F = 5:8 versus M:F = 3:7), POSSUM scores (25 versus 26) and ASA grades. Grip strength was significantly maintained at 24 h in the optimization group (P = 0.03). The time to resume a normal hospital diet was decreased (48 h versus 74 h; P < 0.001). Pain and fatigue scores were significantly reduced in the optimization group on days 1 and 7 (P < 0.05). Cardiopulmonary complications were lower in the optimization group (1/13 (8 per cent) versus 4/10 (40 per cent); P = 0.17). Median length of hospital stay was 3 days (2–7) in the optimization group compared to 7 days (3–10) in controls (P = 0.001). Conclusion: Optimization of surgical care significantly improves patient's physical and psychological function in the early postoperative period and facilitates early hospital discharge.