[Dissemination of fast-track concepts in Germany]. / Verbreitung von Fast-Track-Konzepten in Deutschland.

ABSTRACT

BACKGROUND: Fast-track concepts have fundamentally changed the perioperative care of patients in the last 30 years. Sufficient evidence is available for these concepts. OBJECTIVE: The aim of this article is to evaluate the dissemination of fast-track concepts in Germany based on routine data. MATERIAL AND METHODS: A retrospective analysis of all colorectal resections performed at the Helios Clinics in 2016-2021 was carried out. These were analyzed with respect to the length of hospital stay, intensive care unit occupancy, ventilation proportion, mortality, complication rate and access approach. RESULTS AND DISCUSSION: A transfer to the intensive medical care unit is still the standard in Germany after colorectal resection. For oncological colorectal resection, in particular, two thirds of the patients are still perioperatively treated on the intensive care unit. The duration of inpatient hospital stay for colorectal resection is still excessively long in international comparisons and has also only diminished slowly in recent years (e.g. colon cancer 2016 18.6 ± 11.9 days and 2021 13.8 ± 9.3 days). The proportion of open surgical interventions is declining but still accounts for a relevant proportion even 30 years after the implementation of laparoscopy (e.g. colon cancer 2016 71.10% and 2021 56.44%). Therefore, the care of patients with colorectal resection still does not seem to be implemented according to the fast-track principle.