The fast-track surgery (FTS) concept was introduced by Danish surgeon Kehlet in 2001 [1, 2].The FTS concept refers to the application of various proven methods before, during and after surgery to reduce the stress and complications associated with surgery and other therapeutic management measures and to accelerate the patient’s recovery. It is the synergistic result of a series of effective measures, such as perioperative nutritional support, emphasis on oxygen supply, non-routine application of nasogastric tube decompression, early feeding, application of growth hormone, minimally invasive surgery, etc. The FTS concept was first applied most successfully in the field of colorectal surgery and has gained the most experience, but nowadays, the FTS concept has been gradually extended from the early gastrointestinal surgery to hepatobiliary surgery, urology, cardiothoracic surgery and cranio-cerebral surgery. However, today, the FTS concept has been gradually extended from the early gastrointestinal surgery to hepatobiliary surgery, urology, cardiothoracic surgery, and cranio-cerebral surgery, and the FTS concept has universal guidance for the perioperative treatment of various surgical specialties [3]. However, there are still many surgeons, especially young surgeons do not really know and understand this advanced concept, in some hospitals in China, especially primary hospitals this scientific concept has not been fully popularized and applied, here the author on the FTS concept of perioperative comprehensive treatment of various aspects of the specific guiding principles and measures are summarized and reviewed as follows. 1. Guiding principles and measures of FTS concept on preoperative preparation 1.1 FTS concept on preoperative psychological preparation: preoperative psychological preparation is an important element of the FTS concept, and most patients have different degrees of fear before surgery, worrying about whether the surgery will be successful, whether the postoperative pain can be tolerated, whether complications will occur, etc. Individual patients will have severe tension, anxiety, fear, depression, pessimism, etc. All these factors will inevitably produce adverse stress reactions and lead to excessive preoperative psychological burden, which will hinder the implementation of surgery and postoperative recovery [4]. The recommendations of feeding and getting out of bed are important to relieve their tension and fear, actively cooperate with surgery, smoothly pass the perioperative period, and reduce postoperative complications [4]. 1.2 FTS concept about preoperative diet control The traditional preoperative preparation is 12 h fasting and 4 h water fasting, which will produce many adverse effects such as hunger, thirst, irritability, dehydration, hypoglycemia, blood volume deficiency, etc. In the presence of these unfavorable factors the patient has to suffer another blow of surgery, similar to long-distance running or mountain climbing under starvation, which is a very strong adverse stress to the organism and will have extremely detrimental effects on the organism’s endostasis, leading to increased body consumption and decreased resistance to infection, which affects tissue repair and wound healing [5]. Therefore, the FTS concept abolishes the traditional preoperative fasting time and considers that patients undergoing elective surgery do not need to fast from midnight the day before surgery, and that the time for eating solid food is shortened to 6 h before anesthesia and for eating a liquid diet (e.g., 400 ml of 12.5% glucose solution) is shortened to 2 h before anesthesia. More importantly, the preoperative fasting state will cause postoperative insulin resistance, reducing the ability of insulin to mediate postoperative blood glucose and eventually producing a “diabetes-like” metabolic disorder. Studies have shown that insulin resistance can appear within minutes after surgery and persist for weeks or even months, leading to elevated blood glucose, reduced muscle glucose intake and consequent loss of muscle protein and muscle strength, and weakening of the patient’s postoperative fitness and recovery [6]. Adequate glucose load obtained through preoperative moderate feeding can effectively stimulate insulin secretion and enhance insulin sensitivity, thus effectively alleviating postoperative insulin resistance and reducing postoperative hyperglycemia and various complications caused by it [7]. 1.3 FTS concept on preoperative nasogastric tube placement The traditional view is that gastrointestinal dysfunction or even gastrointestinal paralysis often occurs after gastrointestinal surgery, and the placement of a nasogastric tube can relieve abdominal distension, reduce false aspiration, reduce anastomotic tension, and reduce the incidence of anastomotic fistula. However, the placement of nasogastric tubes is painful for patients and can often cause severe nausea or vomiting, which can be very frightening for patients. Recent studies have shown that nasogastric tubes can weaken the function of the lower esophageal sphincter and gastrointestinal motility, inducing aspiration pneumonia, pulmonary infection, and slower recovery of gastrointestinal function after surgery [8]. Therefore, the FTS concept advocates that nasogastric tubes should not be routinely placed preoperatively, especially for colorectal surgery, and there is a consensus that nasogastric tubes should not be left in place preoperatively, in order to reduce the adverse stress reactions of nasogastric tubes on the body and promote faster recovery after surgery, while nasogastric tube placement should only be used for certain special surgeries and patients with severe postoperative abdominal distension and refractory vomiting [9]. 1.4 FTS concept on preoperative bowel preparation and preoperative medication Recent studies on colon cancer surgery have shown that there is no significant difference between preoperative bowel preparation and no bowel preparation in terms of final treatment outcome and postoperative complications, but on the contrary, bowel preparation is mostly started one day before surgery, and bowel preparation is an adverse stress response to patients, which inevitably affects preoperative diet and preoperative nutritional status, and bowel Intestinal preparation-related drugs such as enemas often lead to intestinal flora displacement, dehydration, acid-base imbalance and electrolyte disturbance, causing changes in the physiological environment, increasing intraoperative blood pressure fluctuations and intraoperative fluid infusion, which together with surgical stress eventually lead to systemic or gastrointestinal tissue edema and further delay the recovery of postoperative gastrointestinal function [10]. Recent meta-analyses have also shown that preoperative bowel preparation may increase the incidence of postoperative anastomotic fistula [11]. Therefore, the FTS concept advocates that preoperative bowel preparation should not be routinely performed, especially mechanical enema bowel preparation should be avoided, and should only be used for patients who require intraoperative colonoscopy, and preoperative oral antibiotics should not be used as routine preoperative preparation, but rather advocate the prophylactic application of antibiotics once 30 min before surgery, and then an additional time during surgery if the operation time is >3 h [12]. 2. FTS concept on intraoperative management principles and measures 2.1 FTS concept on anesthesia selection Accelerated recovery requires multidisciplinary cooperation, and the anesthesia method used for surgery directly affects postoperative recovery. For abdominal surgery, thoracic epidural anesthesia and continuous postoperative analgesia with postoperative non-opioid pain relief are the most effective pain relief measures. Studies have shown that continuous epidural anesthesia can block nerve impulses from target organs, attenuate the response of the pituitary-adrenocortical-sympathetic chain to surgical blows, increase blood supply to the gastrointestinal tract, shorten the duration of intestinal paralysis, and promote early postoperative recovery [13]. Since general anesthesia is not used, the incidence of pulmonary infection and aspiration pneumonia due to the use of general anesthesia is effectively reduced, and if general anesthesia has to be applied, it is advisable to use anesthetics with rapid onset and short duration of action such as desflurane and sevoflurane, as well as short-acting opioids such as remifentanil, thus ensuring that patients can wake up faster after anesthesia and facilitating early postoperative activities [14]. 2.2 FTS concept on intraoperative insulation In China, intraoperative insulation is a long-neglected problem, and we often see patients lying on a cold surgical bed during surgery, shivering all over and with cold, wet limbs. It is believed that patients with surgery lasting more than 2h will experience a decrease in body temperature, and the excitation of the sympathetic-adrenal system during rewarming leads to an increase in the release of catecholamines and epinephrine, which will intensify the stress response of the body to surgery, impair the coagulation mechanism as well as leukocyte function, and increase the rate of postoperative incisional infection by 3 times; increase the cardiovascular burden and predispose to postoperative arrhythmias such as ventricular tachycardia [15]. Good maintenance of intraoperative patient body temperature has the effect of reducing intraoperative bleeding, postoperative infection, cardiac complications, and decreasing catabolism, so maintaining a normal intraoperative body temperature is an important measure to reduce surgical stress and decrease postoperative organ dysfunction [16]. To avoid the occurrence of hypothermia, it is essential to take active preventive measures. For example, (1) strengthen intraoperative coverage to avoid unnecessary exposure; apply warm water bags and electric blankets to keep the patient’s head and lower extremities warm; (2) maintain a warm environment and increase the operating room temperature; (3) strengthen oxygen supply; (4) strengthen temperature monitoring, and for hypothermia, use a thermometer that can measure up to 35 °C and measure rectal body temperature; (5) warm the intravenous infusion of fluid or blood, etc. [17]. 2.3 FTS concept regarding minimally invasive operations and reduction of intraoperative stress All measures of the FTS concept, except for the continued emphasis on minimally invasive surgical techniques, do not change much about specific surgical techniques, but mainly improve and supplement perioperative management, using various methods that have been proven effective to avoid or diminish unnecessary pain and complications for patients, thus accelerating their recovery. For example, surgical operations should be gentle, meticulous, and minimally invasive, and vital signs such as temperature, pulse, respiration, and blood pressure should be kept stable during surgery to reduce adverse stress due to dramatic fluctuations in vital signs [18]. However, even so, surgical stress can still arise, and the main methods to eliminate or attenuate intraoperative stress are the following: (1) the use of epidural anesthesia or regional block anesthesia. The use of these two anesthesia methods can reduce the neuroendocrine metabolic response and the activation of catabolism, reduce the damage to organ function, and reduce the loss of muscle tissue. (2) Drug therapy. Studies have shown that a single dose of glucocorticoids (commonly dexamethasone) given before performing minor surgery can reduce nausea and vomiting and pain, as well as reduce inflammatory responses and have no adverse effects, which can promote accelerated recovery from minor surgery [19]. Other studies have shown that perioperative use of β-blockers can reduce sympathetic excitation, reduce cardiovascular burden and thus cardiac complications, and have also been found to reduce catabolism in burn patients, so that perioperative use of β-blockers may become an important component in accelerated recovery therapy, especially in elderly patients [20]. 2.4 FTS philosophy regarding perioperative fluid replacement Control of fluid input on the day of surgery and in the postoperative period is another important component of the FTS philosophy. Traditional methods tend to give large amounts of fluid input in the perioperative period, 3.5-5 L/d. Such a large amount of fluid input can put the patient’s body in a state of excessive rehydration and even water intoxication, exacerbate cardiopulmonary load, reduce plasma colloid osmotic pressure, and can lead to tissue edema and affect postoperative gastrointestinal function recovery, and such a large amount of fluid can also lead to a drop in body temperature and aggravate postoperative stress response [21]. On the other hand, studies have shown that reducing the amount of fluid input will help to reduce postoperative complications and shorten the postoperative hospital stay [22]. Vasodilation and hypotension due to epidural anesthesia are reasonably managed with vasoconstrictors rather than large amounts of fluids, so intraoperative and postoperative fluid replacement must be strictly managed. Another study has shown that the input of excessive salt solution inhibits and delays the recovery of postoperative gastrointestinal function and prolongs the postoperative recovery process [23]. 3. Guiding principles and measures of FTS concept on postoperative treatment 3.1 Principles and measures of FTS concept on the management of postoperative analgesia Pain is the most common symptom of postoperative patients, which will have adverse effects on their recovery, and effective postoperative pain relief is one of the important elements of FTS concept. Even less severe pain often brings negative psychological and physiological effects such as anxiety, fear and anger to patients, i.e., produces adverse stress, and postoperative pain is often severe, which will definitely affect rest, eating and activities and hinder postoperative recovery. Effective analgesia can improve patients’ anxiety, reduce the occurrence of multi-organ system complications such as heart, lung and coagulation, and is also a necessary prerequisite for early bed activity and early oral nutrition, which are important measures to reduce surgical stress reactions [24]. Currently, analgesic pumps are commonly used in the postoperative period, but such drugs themselves can cause gastrointestinal symptoms such as nausea and vomiting, which increase the discomfort of patients. In recent years, continuous postoperative epidural block has been highly recommended, and studies have shown that continuous postoperative epidural analgesia for 24-72 h can effectively block the transmission of pain to the center in the surgical region and effectively reduce the postoperative stress response after major surgery [25]. When the epidural tube is removed if there is still pain then non-steroidal analgesics such as: ibuprofen and painful lancets are applied to eliminate the inhibitory effect of opioids on bowel movements [26]. 3.2 FTS concept on early postoperative bed activity The FTS concept encourages patients to resume bed activity as soon as possible after surgery, and patients should not be bedridden for a long time after surgery because this will increase muscle loss, reduce muscle strength, impair lung function, aggravate venous stasis and thrombosis, and ways should be found to increase patients’ postoperative activity, which is conducive to promoting anabolism, reducing muscle atrophy, improving lung function and tissue oxygenation and effectively reduces the risk of venous thrombosis [27]. There are differences in when to start activity at home and abroad, and some foreign hospitals allow patients with gastrointestinal surgery to perform appropriate activities at the bedside on the evening of the postoperative period, and on the first postoperative day, patients can walk around the ward corridor, and on the second postoperative day, patients can perform basic normal activities, and they believe that such early postoperative activities are more beneficial to patients’ recovery, and the prerequisite for early bedside activities is effective postoperative pain relief, discontinuation or early removal of drainage tubes, nasogastric tubes and catheters [28]. 3.3 FTS concept regarding early postoperative feeding Some meta-analysis studies have shown that early resumption of oral diet reduces infectious complications and shortens hospital days after abdominal surgery without increasing the incidence of anastomotic fistula [29], whereas the recovery of bowel sounds should not be used as a marker for the recovery of postoperative bowel paralysis and the initiation of feeding. Studies have shown that postoperative gastrointestinal paralysis mainly occurs in the stomach and colon, peristalsis of the small intestine begins to recover in a few hours after surgery, water intake begins 4-6 h after surgery, it is safe to eat liquid food on the first postoperative day, and early feeding can promote recovery of gastrointestinal function and avoid hypoglycemia and dehydration caused by prolonged postoperative fasting, and postoperatively, according to the patient’s specific condition and gastrointestinal tolerance in accordance with the principle of small amount and multiple times and gradual increment Resumption of early postoperative feeding does not increase the incidence of postoperative abdominal distension, nausea, and vomiting [30]. At the same time, early feeding makes early enteral nutritional support possible, providing the necessary nutrition required after surgery. 3.4 FTS concept regarding the management of postoperative nasogastric tubes, drainage tubes and catheters Traditional practice often requires the placement of nasogastric tubes before gastrointestinal surgery and their removal after postoperative recovery of gastrointestinal function and evacuation to reduce postoperative intestinal distension. However, in recent years, randomized controlled trials have found that long-term postoperative nasogastric tubes do not provide much benefit, and the FTS concept suggests that nasogastric tubes are used to keep the stomach empty during anesthesia to prevent aspiration and should be removed as soon as the procedure is completed, if not immediately, then within 24 h after surgery. Long-term indwelling nasogastric tubes can cause a series of pulmonary complications and discomfort, affecting early feeding and thus delaying the patient’s recovery [31]. The traditional view is that drains are not only an important window of observation for the presence of bleeding, exudate, abscess, and anastomotic fistula after surgical procedures, but also an important preventive and therapeutic measure for abscess and anastomotic fistula, but the FTS concept does not believe that there is sufficient evidence that drains do prevent the occurrence of anastomotic fistula, rather the placement of drains increases surgical injury and patient discomfort, restricts postoperative bedtime activities, and It increases the chance of postoperative retrograde infection via drains, increases the total amount of perioperative adverse stress, and delays the patient’s postoperative recovery process. Therefore, the FTS concept advocates that intraoperative drains should not be routinely placed, especially in abdominal surgery, because the peritoneum has a strong absorptive function, and when the analysis shows that only exudate will appear in the peritoneal cavity, the placement of drains will not be necessary at all, and even if drains are placed, they should be removed as soon as possible if no significant drainage is observed within 1 to 2 days after surgery, provided that obstruction of the drains is excluded [32]. Catheters should likewise be removed as soon as possible postoperatively; long-term indwelling catheters increase the chance of urinary tract infection and aggravate the patient’s discomfort. For general abdominal surgery, the catheter should be removed within 1 day postoperatively; for low rectal surgery, the catheter should be removed within 3 days postoperatively [33]. 4, for the outlook of the FTS concept Currently, accelerated rehabilitation surgery is now widely used in several surgical specialties, and its main purpose is to reduce adverse perioperative stress and complications through a variety of proven measures to promote the functional recovery of patients’ organs after surgery, shorten patients’ postoperative recovery time, and achieve the goal of early recovery. Any medical measures will produce negative effects along with positive effects, and individual negative effects can be small (e.g. intravenous or intramuscular injection), and different individuals have strong and weak stress reactions to them (e.g. individual pain-sensitive people can even have strong overreactions to intramuscular injection – “All these small adverse stress reactions can be accumulated and superimposed to become a larger stress reaction to the organism, and we cannot underestimate these insignificant small stress reactions. It is clear that the concept of accelerated recovery surgery is the result of a combination of effective management measures [34, 35].The FTS concept does not have a fixed model or scheme, but is in the process of continuous development and improvement. The concept of FTS is based on the fact that the successful implementation of accelerated rehabilitation surgery is not a single discipline, but a multidisciplinary approach (surgeons, nurses and anesthesiologists). Surgeons, nursing and anesthesiology), and the scope for its development is enormous [36]. As a modern clinical surgeon, we should not be indifferent and indifferent to this advanced concept, but should seriously study and understand the essence and substance of this concept, and actively apply this concept to guide our clinical work, so that the FTS concept is transformed into specific therapeutic treatment measures, and continuously test, enrich and develop this concept in clinical work, in order to finally achieve the purpose of accelerating patient recovery.