Dr Gatt and colleagues compared multimodal optimization with conventional perioperative management.
The investigators evaluated a consecutive series of patients undergoing a wide range of colorectal procedures.
The investigative team prospectively recruited 39 patients undergoing major elective colonic resection.
Patients were randomized to receive a 10-point multimodal optimization package or conventional perioperative care.
All patients were administered epidural analgesia and opiates were avoided.
The team recorded outcome measures related to length of hospital stay, physical and mental function, and gut function.
The investigators found that optimization was associated with a significantly shorter median hospital stay compared with conventional care.
| Duration of catheterization was less|
|British Journal of Surgery|
Duration of catheterization and duration of intravenous infusion were also less.
The team noted that optimization was associated with a quicker recovery of gut function.
Grip strength was maintained in the postoperative period in the optimized group but not in the control group.
The investigators observed no differences in morbidity or mortality between the groups.
Dr Gatt's team commented, “Optimization is safe and results in a significant reduction in postoperative stay along with other improved endpoints.”
“This cannot be directly attributed to improvement in any single outcome measure or to the use of epidural analgesia.”
“Improvements are more likely to be multifactorial and may relate to an earlier return of gut function.”