Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme

TLDR

Typical colonic surgery requires 5–10 days of hospitalization due to pain, ileus, organ dysfunction, and fatigue, while laparoscopic approaches can reduce this to about five days. This study evaluates a multimodal rehabilitation program following open sigmoidectomy. Sixteen elective sigmoidectomy patients (median age 71) received combined spinal–epidural anesthesia, with 48‑hour epidural analgesia, immediate oral nutrition, early mobilization, and a planned 48‑hour discharge. The program shortened median stay to 2 days (range 2–6), enabled rapid oral intake and bowel function, maintained low pain and fatigue, and resulted in no major complications within 30 days, demonstrating that effective pain control integrated into accelerated rehabilitation can accelerate recovery after open colonic surgery.

Abstract

Abstract Background Hospital stay after colonic surgery is usually between 5 and 10 days, limiting factors being pain, ileus, organ dysfunction and fatigue. Single-modality intervention to reduce these factors with laparoscopic surgery usually requires a hospital stay of 5 days. This paper reports the results of a multimodal rehabilitation regimen after open sigmoidectomy. Methods Sixteen unselected patients scheduled for elective sigmoid resection (median age 71 years) underwent operation under combined spinal–epidural anaesthesia. After operation, epidural analgesia was continued for 48 h, with immediate oral nutrition and mobilization, and with planned discharge 2 days after surgery. Results The median postoperative hospital stay was 2 (range 2–6) days (48 h), patients being mobilized for a median of 5 h on the second postoperative day (24–48 h) and for 10 h on the third day (48–72 h). Within 48 h of operation 14 patients had an oral intake of 2000 ml or more and 15 had resumed defaecation. Fatigue and pain scores were low during the first 8–9 days after operation, with a median of 13 h of mobilization per day after discharge. There were no medical or surgical complications during 30 days of follow-up, except for two patients who suffered postspinal headache. Conclusion Postoperative recovery after open colonic surgery may be accelerated by effective pain relief integrated into an accelerated rehabilitation programme.