L. NDAYIZEYE2, J. Rickard1,2, A. K. KiSwezi2, L. NDAYIZEYE2 1University Of Minnesota,Minneapolis, MN, USA 2University Of Rwanda,Kigali, KIGALI, Rwanda
Introduction:
Fast Track Surgery (FTS) was started in the 1990’s initially for colorectal surgery, but later became applicable to other aspects of surgery. Core elements of FTS include optimal pain control with early initiation of mobilization and feeding. FTS in high-resource settings has been shown to be beneficial with decreased hospital stay, reduced complications and lower costs. There is limited data on FTS in low-resource settings. The aim of this study was to evaluate the impact of FTS among patient undergoing abdominal surgery at a Rwandan referral hospital
Methods:
Adult patients undergoing elective, abdominal surgery were randomized to FTS versus conventional management. Interventions for FTS included early feeding, early mobilization, pain control and discharge planning. Primary outcome was length of hospital stay and secondary outcome was complication rate
Results:
Sixty two patients were enrolled in the study with 31 randomized to FTS and 31 patients undergoing conventional management. 30 (97%) FTS patients received enteral nutrition within 24 hours postoperatively compared with 15 (48%) patients with conventional management (p<0.0001). 30 (97%) FTS mobilized within 24 hours compared with 7 (23%) patients with conventional management (p<0.0001). Pain was adequately controlled with non-opiate medications in 24 (77%) FTS patients. In the conventional management group, 26 (84%) patients received opiates. The mean hospital stay for FTS patients was 2.1 days and the mean hospital stay for patients with conventional management was 5.3 days (p<0.001). There was no difference in complication rates between the groups.
Conclusion:
In a low-resource setting, implementing FTS management with early nutrition, mobilization and decreased opiate use reduces length of hospital stay without increasing complications.