Fast-track surgery in India.
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Date
2014-03
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Abstract
Fast-track surgery or ‘enhanced recovery after surgery’ or
‘multimodal rehabilitation after surgery’ is a form of protocolbased
perioperative care programme. It is an amalgamation of
evidence-based practices that have been proven to improve
patient outcome independently and exert a synergistic effect
when applied together. The philosophy is to treat the patient’s
pathology with minimal disturbance to the physiology. Several
surgical subspecialties have now adopted such protocols with
good results. The role of fast-track surgery in colorectal
procedures has been well demonstrated. Its application to
other major abdominal surgical procedures is not as well
defined but there are encouraging results in the few studies
conducted. There has been resistance to several aspects of this
programme among gastrointestinal and general surgeons.
There is little data from India in the available literature on the
application of fast-tracking in gastrointestinal surgery. In a
country such as India the existing healthcare structure stands
to gain the most by widespread adoption of fast-track methods.
Early discharge, early ambulation, earlier return to work and
increased hospital efficiency are some of the benefits. The cost
gains derived from this programme stand to benefit the
patient, doctor and government as well. The practice and
implementation of fast-track surgery involves a multidisciplinary
team approach. It requires policy formation at an institutional
level and interdepartmental coordination. More research is
required in areas like implementation of such protocols across
India to derive the maximum benefit from them.
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Citation
NANAVATI ADITYA J, NAGRAL SANJAY, PRABHAKAR SUBRAMANIAM. Fast-track surgery in India. National Medical Journal of India. 2014 Mar-Apr ; 27 (2): 79-83.