Implementing fast track protocol in gastrointestinal surgeries for early ambulation and discharge from hospital

Background and objectives: Enhanced Recovery after Surgery (ERAS) or Fast-track Surgery (FTS) or Multimodal Surgery is a single program incorporating multimodal interventions in the perioperative period to expedite recovery. It involves using various strategies to facilitate better conditions for surgery and faster recovery with rapid resumption of normal activities without an increase in post-op complications or readmissions. Methods: A Prospective Interventional Randomised Controlled study was carried out at a Armed Forces Tertiary Care Hospital by selecting 60 patients undergoing elective gastrointestinal surgery with an Anastomosis anywhere in the Gl tract distal to (and including) the ileum. The patients were divided, after baseline parameters were recorded, by stratified randomization on the basis of the type of surgery required into case and control groups and subjected to 'fast track' and traditional protocols of peri-operative care and their post-operative recovery. Results: The case group had an earlier discharge from hospital with a mean of 4.73 days while the control group had a mean discharge day of 7.27 days. The rate of complications and readmission were not significantly different. Conclusion: Fast Track protocol represent a paradigm shift in perioperative care based on simple and evidence based principles. It has resulted in a significantly increased understanding of perioperative physiology and its modifications to improve outcomes. With simple, cost effective measures, ERAS is a vital and powerful tool in decreasing length of stay, complication and re-admission rates.