Abstract
Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.
Highlights
Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS)
The aim of this study is to identify patients following a FTS program [6] who have been discharged earlier than anticipated, being day 2 post op after major gynaecological/gynaecological oncologic surgery and analyse elements that may have aided in their early discharge
The improvement in surgical outcomes demonstrated in FTS programs has allowed as a consequence a reduction in the hospital LOS
Summary
Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). On average 5 - 7 days post surgery [1]. Fast Track Surgery (FTS) or Enhanced Surgical Recovery (ESR) programs have been developed and refined in many specialties with documented improved patient outcomes and as a consequence earlier discharge form hospital and reduced length of stay (LOS) [1,2,3,4,5]. The aim of this study is to identify patients following a FTS program [6] who have been discharged earlier than anticipated, being day 2 post op after major gynaecological/gynaecological oncologic surgery and analyse elements that may have aided in their early discharge
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