Fast track surgery at the University Teaching Hospital of Kigali: a randomized controlled trial study in abdominal surgery

Abstract

Background: Fast Track Surgery is synonymous with Enhanced Recovery after Surgery. It was started in the 1990’s initially for colorectal surgery, but later became applicable to other aspects of surgery. Its core elements include epidural or regional anaesthesia, perioperative fluid management, minimally invasive surgical techniques, optimal pain control, early initiation of mobilization and feeding, and early discharge from hospital. The beneficial effects of this practice arise from early mobilization and feeding, and the reduced hospital stay. They include reduced costs, early discharge from hospital, and increased availability of hospital beds. The main aim of this study was to explore the feasibility of Fast Track Surgery in the Rwandan surgical setting and to demonstrate the reported beneficial effects of Fast Track Surgery.

Methods: A randomised control trial was conducted, with cases for Fast Track Surgery (FTS) carefully selected, and compared with the controls (patients going through the conventional surgical care). A total of 62 patients (31 in each group) were studied. Evaluation and comparison of hospital stay, early mobilization, early feeding, complication rate, were done for the two groups.

Results: The FTS patients had a mean hospital stay of 2.1 days, while the controls had a mean hospital stay of 5.3days. 97% of the FTS patients had early mobilization, within the first 24 hours postoperatively, compared to 77% who got mobilization and feeding on the 3rd postoperative day in the control group.

Conclusion: Fast Track Surgery practice is feasible in the Rwandan surgical setting. It facilitates early discharge from hospital, with minimal complication rates because of early mobilization and early feeding. It also results in reduced postoperative pain, leading to reduced or no opoid demands. All these translate into reduced expenses for the patient and the hospital.

Keywords: Fast Track Surgery, hospital stay, mobilization, beneficial effects, Randomised control trial