A Prospective Evaluation of Clinical Outcomes with Fast Track Protocols for Colorectal Surgery in an Eastern Caribbean Nation

Abstract

Background: Fast track protocols (FTPs) have triggered considerable improvements in patients’ perioperative care and are accepted as the standardised approach to patient management in developed countries globally. Although the benefits of FTPs have been illustrated for some time, they are not universally used in developing countries. In the Eastern Caribbean, FTPs are implemented in an ad-hoc manner based on the attending surgeons.

Methods: We designed a comprehensive FTP modified for use in Barbados, an island nation in the Eastern Caribbean. After consensus, the FTPs were introduced into clinical practice at a tertiary referral public hospital. We prospectively evaluated clinical outcomes after introduction of FTP protocols for all patients undergoing colorectal operations from January 1, 2018 to February 1, 2019. The study population was divided into three groups: Group I: full adherence (>16 FTP steps completed), Group II: partial adherence (10-15 FTP steps completed), Group III: non-adherence to FTP protocols (<9 FTP steps observed). In each group, we compared morbidity, mortality, return of bowel function, length of post-operative hospital stay and hospital readmission using SPSS version 20 for statistical analyses. 

Results: Over the study period, there were 27 colorectal operations performed. When the outcomes in group 1 and group 3 were compared, there was a statistically significant reduction in post-operative LOS (3 Vs 8.9 days; P<0.05) and overall morbidity (10% vs 50%; P 0.05) in the full FTP adherence groups.

Conclusions: In this Caribbean healthcare system, FTP implementation resulted in significant improvements in post-operative duration of hospitalization and overall morbidity. The main challenge is to achieve universal buy-in from health care providers in the Caribbean. We believe that the way to achieve this is continued medical education and targeted research to acquire local practice data from the Caribbean. We advocate the incorporation of FTP into colorectal surgical practice for Caribbean hospitals.