Postoperative care pathways

Strategies for post-operative care after abdominal surgery are highly variable depending on the training, culture, experience and personal opinions of the attending surgeon. Over the last decade, several authors have provided data allowing a better understanding of postoperative physiology, and of potential methods by which hospital stay can be shortened. The development of standardized "fast track" post-operative care pathways has lead to markedly reduced hospital stay in several series. Post-operative care pathways tend to include early ambulation, early introduction of oral liquids and diet, and some authors have sent patients home taking clear liquids, or without waiting for recovery of bowel function. Others use pathways including transverse and oblique abdominal incisions, pre-emptive thoracic epidurals and oral cathartics after surgery. This review evaluates the available options for integration into post-operative care pathways. The evidence level and grade of recommendation is described for each of these components. The specific components of several options for post-operative care pathways, including that published by our group, are then given.