Track Protocol Research Articles

LONG–TERM FOLLOW–UP IN PATIENTS ON PCSK9 INHIBITOR THERAPY: COMBINING FAST TRACK STRATEGY AND OUTPATIENT MANAGEMENT

Abstract Background Dyslipidemia is a significant risk factor for cardiovascular diseases, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have emerged as an effective treatment option. This study aims to investigate the lipid profile in the long–term follow–up of dyslipidemic patients receiving PCSK9 inhibitor therapy in an entirely outpatient setting. Methods We enrolled 381 patients from our dyslipidemia outpatient clinic. Study population included both patients with a first dyslipidemia visit and those discharged from a cardiology unit with fast fast–track protocol. Patients were followed up at 6 (n = 252), 12 (n = 191), and 36 months (n = 77) to assess the effects of PCSK9 inhibitor therapy on lipid profile. Results At the 6–month follow–up, the total cholesterol levels decreased significantly (223.1±35.2 mg/dL vs 129.6±31.9 mg/dL p < 0.001) as LDL cholesterol levels (148±45 vs 72.6±46 mg/dL p < 0.001). The 12–month follow–up maintained similar levels of lowering (total cholesterol 123.6±39 mg/dL LDL 67.5±41 mg/dL p < 0.001) as well as the 36–month follow–up (total cholesterol 138.1±43 mg/dL LDL 71.6±44 mg/dL p < 0.001). No significant reductions in triglycerides and HDL levels were observed during follow–up. Conclusion The study highlights the feasibility and effectiveness of the long–term management of dyslipidemic patients with PCSK9 hypercholesterolemia in an entirely outpatient setting, including patients referred through the fast–track protocol.

Implementation of the Fast-track Protocol for Total Hip Arthroplasty in a Public Hospital in the State of São Paulo - Brazil.

Objective Evaluate the results of the implementation of the Fast Track Protocol (FTP), a medical practice based on scientific evidence, for elective total hip arthroplasty surgery, mainly comparing the National Average Hospital Admission Rate of 7.1 days. Methods 98 patients who underwent elective total hip arthroplasty surgery via the direct anterior approach, anterolateral approach and posterior approach were included in the FTP from December 2018 to March 2020, being followed up preoperatively, intraoperatively and immediately postoperatively. Results The average length of hospital stay was 2.8 days, being 2.1 days for the direct anterior approach, 3.0 days for the anterolateral access approach and 4.1 days for the posterior access approach. The average surgery time was 90 minutes, 19 (19.39%) of the patients were referred to the ICU in the postoperative period, however, none of them underwent surgery using the direct anterior approach. We had no cases of deep vein thrombosis (DVT), pulmonary embolism (PTE) or neurological injury, 19 (19.39%) patients had postoperative bleeding requiring dressing change, 4 (4.08%) needed blood transfusion, 2 (2.04%) patients had implant instability, 1 (1.02%) patient had a fracture during surgery and 1 (1.02%) patient died of cardiac complications. Conclusion FTP may be a viable alternative to reduce the length of stay and immediate postoperative complications for elective total hip arthroplasty surgery decreasing the length of stay of patients by 2 to 3 times when compared to the national average of 7.1 days.

Hepatic Resection coupled with Fast Track Protocol

Hepatic Resection coupled with Fast Track Protocol

Navigator nurse implementation within a fast track program of liver resections: How to improve the healthcare service and perioperative results.

The introduction into the clinical practice of the navigator nurse (NaNu) to address the task of counseling and short term follow-up help the effective implementation of the fast track protocol. The aim of the present study was to investigate the impact of the standardization of the NaNu's role in patients undergoing liver surgery. Patients undergoing elective liver surgery for all diagnosis and approach, from 2015, received counseling and postoperative follow-up by NaNu and constituted the study group (n=890). This group was compared with the control group (n=712) including patients treated in the era before the implementation of the NaNu role (2011-2014). Outcome was evaluated in terms of discrepancy between functional recovery and discharge, number of ER accesses, number of readmissions. Preoperative characteristics of patients and disease, as well as type of resection and postoperative outcomes were similar between the two groups. The proportion of laparoscopic cases was higher in the study group (51.2% vs. 32% in the control). Time for discharge, interval between functional recovery and discharge, number of ER accesses and number of readmissions were reduced in the study group. Benign diagnosis, absence of complications, laparoscopic approach and presence of NaNu were independent predictors of shorter length of stay. The positive effect of NaNu's activation was recorded in patients with complications and undergoing open surgery. The implementation of NaNu's role has allowed to us optimize the level of healthcare service offered to patients. The wider benefit was offered in the setting of complex patients.

Pharmacoeconomic evaluation of the accelerated recovery and blood saving program in extended combined operations on the pelvic organs

Background: The newly diagnosed pelvic cancer appears to be locally advanced in every third patient, which requires a comprehensive approach to treatment and often extensive combined surgical interventions. Long duration of operations, blood loss, complications of the tumor process during or after previous treatment often lead to the development of complications, slow rehabilitation and increasing cost of treatment. The use of fast track protocol (FTP) and blood-saving technologies can reduce the impact of these adverse factors.Aim: The evaluation of the pharmaco-economic efficiency of fast track protocol and blood-saving technologies in patients after extended combined operations for pelvic tumors.Materials and methods: The study included 111 patients with pelvic tumors who underwent an extensive combined surgery for rectal or gynecological tumors. Among them, 52 patients were underwent the same fast track protocol with a focus on the use of blood-saving technologies (2020–2021), the management of patients in the control group was more conservative (n = 59, 2018–2019). After analyzing the factors affecting the treatment outcomes, 2 groups of 16 patients comparable in basic clinical indications were formed by selection of pairs patients using quasi-randomization to assess the direct costs of treatment.Results: The cost of treatment in the FTS group and the control group was 157744 ± 32728,72 and 273429 ± 217931,5 (P < 0,05) rubles, respectively. The lower blood loss (206 ± 70 ml vs 430 ± 208, р = 0,3) allowed for a statistically significant difference in the frequency of transfusion of blood components (2 vs 12, p < 0,0009), despite the higher cost of supplies in the FTS group (132913 vs 57347 rubles). Also, the resuscitation bed-day (1,75 ± 1,3 vs 3,5 ± 2, р = 0,5) and the postoperative bed-day (16,8 ± 8; 8–32; vs 27 ± 18, р = 0,6) were lower in the FTS group.Conclusion: According to our data using the fast track protocol and blood-saving technologies in a group of patients with locally extensive pelvic organs tumors has helped to reduce the cost of treatment and improve the efficiency of the hospital.

A comparison of bolus track and test bolus computed tomography pulmonary angiography and the implications on pulmonary and aortic vessel enhancement, effective dose and suboptimal scan rate.

Bolus track and test bolus are the most commonly used contrast timing protocols to undertake computed tomography pulmonary angiography (CTPA). The aim of this study was to compare test bolus and bolus track contrast enhancement protocols in terms of enhancement of the pulmonary vessels and aorta, radiation dose and suboptimal scan rate to determine the optimal technique for CTPA. A total of 200 CTPA examinations (100 using each protocol) performed between January and February 2021 were assessed retrospectively. All scans were performed on a 2x128 Dual Source Siemens Drive Scanner. CT attenuation was measured in Hounsfield Units (HU), with measurements taken from the main pulmonary trunk, right pulmonary artery and left pulmonary artery, ascending and descending aorta. The mean effective dose was calculated from the dose-length product (DLP). The suboptimal scan rate was calculated as the percentage of examinations below 210HU. The average HU of the pulmonary arteries was 358 HU ± SD 129.2 in the test bolus group and increased to 394 HU ± SD 133.9 in the bolus track group with a P value of ≤0.05. The average HU of the aorta was 235 HU ± SD 82.8 in the test bolus group and increased to 319 HU ± SD 91.8 in the bolus track group with a P value of <0.001. Although not statistically significant, the mean effective dose was reduced by 4.2% for the bolus track protocol (2.4 mSv vs. 2.5 mSv, P > 0.05). Fewer suboptimal scans were performed with the bolus track protocol (5 scans <210HU Bolus Track vs. 9 scans <210HU Test Bolus). The bolus track protocol results in increased enhancement of the pulmonary arteries and aorta, with the added benefits of a lower suboptimal scan rate and lower effective dose.

Achieving durable compliance with venous thromboembolism prophylaxis in bariatric surgery: 3-year data from a major academic medical center

BackgroundMetabolic and bariatric surgery (MBS) venous thromboembolism (VTE) prescribing practices vary widely. Our institutional VTE prophylaxis protocol has historically been unstandardized. ObjectivesTo create a standardized MBS VTE prophylaxis protocol, track protocol compliance, and identify barriers to protocol compliance and address them with Plan-Do-Study-Act (PDSA) cycles. SettingSingle Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited academic hospital. MethodsWe conducted a retrospective study for all patients undergoing MBS (January 2019 to September 2022). A multidisciplinary group of bariatric clinicians reviewed literature and developed the following standardized VTE prophylaxis protocol: 5000 units preoperative subcutaneous (SC) heparin within 60 minutes of anesthesia induction and postoperative 40 mg SC low molecular weight heparin (LMWH) within 24 hours of surgery. This protocol was distributed to relevant clinical stakeholders. We assessed monthly compliance rates through chart review. Goal compliance was ≥90%. We identified sources of noncompliance and addressed them with PDSA methodology. ResultsA total of 796 patients were included. Preoperative heparin administration increased from a mean of 47% (107/228) preintervention to 96% (545/568) postintervention (P < .0001), and postoperative LMWH administration increased from 71% (47/66) to 96% (573/597, P = .0002). These compliance rates were sustained for 3 years. Barriers to protocol noncompliance included order set timing errors (n = 45), surgeon error (n = 44), surgeon discretion (n = 40), and nursing error (n = 20). No change in bleeding or VTE rates was observed. ConclusionsDeveloping a standardized VTE prophylaxis protocol, monitoring process measures, and engaging relevant stakeholders in PDSA cycles resulted in drastic and durable improvement in VTE prophylaxis compliance rates.

Clinical Results Before and After Implementation of a Fast - Track Protocol For 507 Patients Who Underwent Total Knee Arthroplasty Surgery: A Retrospective, Observational Study

Clinical Results Before and After Implementation of a Fast - Track Protocol For 507 Patients Who Underwent Total Knee Arthroplasty Surgery: A Retrospective, Observational Study

Fast Track Protocols and Early Rehabilitation after Surgery in Total Hip Arthroplasty: A Narrative Review.

The Enhanced Recovery After Surgery (ERAS) or Fast Track is defined as a multi-disciplinary, peri- and post-operative approach finalized to reduce surgical stress and simplify post-operative recovery. It has been introduced more than 20 years ago by Khelet to improve outcomes in general surgery. Fast Track is adapted to the patient's condition and improves traditional rehabilitation methods using evidence-based practices. Fast Track programs have been introduced into total hip arthroplasty (THA) surgery, with a reduction in post-operative length of stay, shorter convalescence, and rapid functional recovery without increased morbidity and mortality. We have divided Fast Track into three cores: pre-, intra-, and post-operative. For the first, we analyzed the standards of patient selection, for the second the anesthesiologic and intraoperative protocols, for the third the possible complications and the appropriate postoperative management. This narrative review aims to present the current status of THA Fast Track surgery research, implementation, and perspectives for further improvements. By implementing the ERAS protocol in the THA setting, an increase in patient satisfaction can be obtained while retaining safety and improving clinical outcomes.

Two Models for Increasing the Scope and Activities of Human Immunodeficiency Virus Partner Services Programs: Preliminary Findings From the Fast Track Project.

We sought to develop a novel strategy for expanding an existing human immunodeficiency virus (HIV) partner services (PS) model to provide comprehensive sexual health services, including sexually transmitted infection testing, a virtual telemedicine visit, and access to immediate start medication (antiretroviral treatment, preexposure or postexposure prophylaxis). Fast Track was a National Institutes of Health-funded implementation science trial in New York City to pilot and refine the new strategy, and examine its feasibility, acceptability, and impact. Over the course of 1 year, health department staff collaborated with the academic research team to develop Fast Track protocols and workflows, create a cloud-based database to interview and track patients, and train disease intervention specialists to deliver the new program. The initial field-based program (Fast Track 1.0) was piloted March to December 2019. A modified telephone-based program (Fast Track 2.0) was developed in response to COVID-19 pandemic constraints and was piloted August 2020 to March 2021. These 2 pilots demonstrate the feasibility and acceptability of integrating comprehensive sexual health services into HIV PS programs. Disease intervention specialists were successfully trained to conduct comprehensive sexual health visits, and clients reported that the availability of comprehensive sexual health services made them more willing to engage with PS. Key lessons for scale-up include managing collaboration with a licensed provider, navigating technical and technological issues, and challenges in client engagement and retention. The success of this integrated strategy suggests that telehealth visits may be a critical gateway to care engagement for PS clients. This model is an innovative strategy for increasing engagement with HIV testing, prevention, and treatment for underserved populations.

Fast Track Protocol in Bariatric Surgery

Fast Track Protocol in Bariatric Surgery

BS O09 Enhanced recovery and fast track surgery is applicable with good outcomes in patients undergoing bariatric surgery

Abstract Background Fast track surgery is well established in major centres undertaking bariatric surgery Methods All patients who underwent bariatric surgery in a high volume centre were included. Patient outcomes in terms of complication rates, length of stay, one day discharge rate and 30 day readmission rate were analysed. Results 1009 patients (105 gastric band removal, 756 gastric bypass, 104 sleeve gastrectomy and 44 revision surgery) were included in the study. Demographics include: Age 46(20–77), M:F = 190–819; BMI – 44.3 (20.6–62); Wt. – 120.3 Kg (57.4–190.7). Median length of stay was 1.7 (1–23) with 79% 1 day discharge. 19 patients had complications (1.8%) with no mortality. Logistic regression analysis revealed that presence of co-morbidities (OR = 1.92; 95% CI: 1.26–2.94; p=0.002) and history of previous abdominal surgery (OR = 2.22; 95% CI: 1.27–3.89; p = 0.005) increases risk of delayed discharge. The 30 day readmission rate was significantly higher in patients who had concomitant surgery in addition to primary bariatric surgery (Chi squared test p=0.032) and patients who failed the fast track protocol (p-0.000; chi squared = 13.2) Conclusions Increased understanding of factors which can be optimised may result in even better outcomes in fast track bariatric surgery.

Postoperative outcomes of Fast-Track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal

We aimed at comparing perioperative outcomes in patients submitted to radical cystectomy followed by Fast Track (FT) protocol or standard management, and propose a definition of Trifecta, to improve standardized quality assessment for RC. We considered 191 patients submitted to RC between January 2017 and January 2019. Patients followed FT or standard management according to surgeon's preference. Preoperative and intraoperative characteristics, alongside with postoperative outcomes were compared between the two groups. Trifecta was defined as follows: in-hospital stay (HS) ≤ 10 days, time to defecation (TtD) below the overall mean and no major (≥ Clavien-Dindo grade III) complications. Finally, Trifecta achievement rates were assessed in both groups. Seventy-five patients (39%) followed the FT protocol and 116 (61%) standard management. The two groups were homogeneous for preoperative, intraoperative and pathological characteristics. Patients in the FT group had shorter TtD (5 vs. 6 days P=0.006), HS (12 vs. 14 days P=0.008) and lower readmission rate (8% vs. 19% P=0.04). Early complication rates and grades were similar, while less late complications were found in FT group (6.7% vs. 21.6% P=0.006). Trifecta achievement rate was higher for FT group (31% vs. 8% P<0.001). Single-item failure percentages for HS, TtD and major grade complications were respectively 90%, 60% and 19%, with no difference between the two groups. FT protocol can safely consent faster bowel recovery and earlier discharge after RC, plus reducing readmission rates. Using a Trifecta incorporating essential perioperative outcomes, could improve standardized quality assessment for RC.

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

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 (&gt;16 FTP steps completed), Group II: partial adherence (10-15 FTP steps completed), Group III: non-adherence to FTP protocols (&lt;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&lt;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.

Feasibility and outcomes of ERAS protocol in elective cT4 colorectal cancer patients: results from a single-center retrospective cohort study

BackgroundPrograms of Enhanced Recovery After Surgery reduces morbidity and shorten recovery in patients undergoing colorectal resections for cancer. Patients presenting with more advanced disease such as T4 cancers are frequently excluded from undergoing ERAS programs due to the difficulty in applying established protocols. The primary aim of this investigation was to evaluate the possibility of applying a validated ERAS protocol in patients undergoing colorectal resection for T4 colon and rectal cancer and to evaluate the short-term outcome.MethodsSingle-center, retrospective cohort study. All patients with a clinical diagnosis of stage T4 colorectal cancer undergoing surgery between November 2016 and January 2020 were treated following the institutional fast track protocol without exclusion. Short-term postoperative outcomes were compared to those of a control group treated with conventional care and that underwent surgical resection for T4 colorectal cancer at the same institution from January 2010 to October 2016. Data from both groups were collected retrospectively from a prospectively maintained database.ResultsEighty-two patients were diagnosed with T4 cancer, 49 patients were included in the ERAS cohort and 33 in the historical conventional care cohort. Both, the mean time of tolerance to solid food diet and postoperative length of stay were significantly shorter in the ERAS group than in the control group (3.14 ± 1.76 vs 4.8 ± 1.52; p < 0.0001 and 6.93 ± 3.76 vs 9.50 ± 4.83; p = 0.0084 respectively). No differences in perioperative complications were observed.ConclusionsResults from this cohort study from a single-center registry support the thesis that the adoption of the ERAS protocol is effective and applicable in patients with colorectal cancer clinically staged T4, reducing significantly their length of stay and time of tolerance to solid food diet, without affecting surgical postoperative outcomes.

Comparison of a fast track protocol and standard care after hip arthroplasty in the reduction of the length of stay and the early weight-bearing resumption: study protocol for a randomized controlled trial

BackgroundTo date, hip arthroplasty is one of the most commonly performed surgical procedures, with growing worldwide demand. In recent decades, major progress made in terms of surgical technique, biomechanics, and tribology knowledge has contributed to improve the medical and functional management of the patient. This study aims to assess if the application of a fast track protocol, consisting of a preoperative educational intervention, adequate postoperative pain control, and intensive rehabilitation intervention, reduces the length of stay (LOS) and allows the early functional recovery compared to standard clinical practice for patients undergoing hip arthroplasty.MethodsThe study population consists of 90 patients with primary arthrosis of the hip with an anterior indication of hip arthroplasty. The exclusion criteria are older than 70 years, a contraindication to performing spinal anesthesia, and bone mass index (BMI) greater than 32. Participants, 45 for each group, are randomly allocated to one of two arms: fast track clinical pathway or standard care protocol. During allocation, baseline parameters such as Harris Hip Score (HHS) and Western Ontario and McMaster Universities (WOMAC) index are collected. On the third postoperative day, the functional autonomy for each patient is assessed by the Iowa Level of Assistance (ILOA) scale, and it is expected the discharge for patients in the fast track group (primary outcome). On the other hand, standard care patient discharge is expected after 5–7 days after surgery. During follow-up fixed at 6 weeks and 3, 6, and 12 months, HHS and WOMAC scores are collected for each patient (secondary outcomes).DiscussionAlthough total hip replacement has become a widespread standardized procedure, to the authors’ knowledge, only few randomized controlled trials were performed to evaluate the effectiveness of fast track pathway vs. standard care procedure in the reduction of the LOS after hip arthroplasty. It is expected that our results collected by the application of minimally invasive surgical interventions with concomitant management of perioperative pain and bleeding and early functional rehabilitation will contribute to enriching the understanding of clinical and organizational aspects linked to fast track arthroplasty.Trial registrationClinicalTrials.gov NCT03875976. Registered on 15 March 2019—“retrospectively registered”.

Abstract P824: Ready, Set, Go! Covid-19 Pandemic Drives Creation of Fast Track Alteplase Protocol

Background: In response to the pandemic, our facility recognized the need to safely decompress ICUs to create space for critically ill COVID-19 patients. Stroke leadership identified select recipients of Alteplase to have care safely de-escalated from ICU to stepdown status earlier than the traditional protocol allowed. Per previous protocol, all stroke patients recovered in ICU for 24 hours post-Alteplase with 36 neurological and vital sign assessments completed. Acting upon the need to ensure patient safety and create inpatient ICU bed availability, the multidisciplinary stroke leadership team created the Fast Track Alteplase Protocol. Goals: Project goals included decreasing ICU utilization and minimizing nursing encounters at the patient bedside to decrease potential COVID-19 exposures. Methods: Protocol qualifications include both pre-Alteplase NIH Stroke Scale scores less than 10 and no large vessel occlusions or flow limiting stenosis present on imaging. Once in the protocol, to qualify for transfer out of ICU, an NIH Stroke Scale score less than 10 throughout ICU stay, non-contrast head CT or MRI to evaluate infarct burden, not require continuous anti-hypertensive medications to maintain systolic blood pressure cap, and not demonstrate hemodynamic or respiratory concerns must be achieved and completed. We developed education for nurses and physicians in ED, ICU, and stepdown patient care areas and tip sheets to guide nursing care and documentation associated with the new protocol. Electronic orders were quickly developed and integrated as a new subphase specific to the Fast Track Alteplase Protocol within an existing stroke order set. Results: The protocol decreased the number of encounters between nursing and patients from 36 to 12 interactions (66.7%) and planned time in the ICU from 24 to 12 hours (50%). The median time comparison of ICU length of stay for Fast Track vs. traditional protocol was 12 hours and 26 min vs 35 hours and 15 minutes respectively. Conclusion: The protocol achieved both goals of decreasing the amount of time stroke patients are in the ICU and number of nursing encounters reducing the possibility of patient and staff exposure to COVID-19.

Implementation of a perioperative protocol to enhance open aortic repair

BackgroundAlthough appreciated for its long-term benefits, open repair of abdominal aortic aneurysms (AAA) is associated with a significant perioperative burden. Enhanced recovery and fast track protocols have improved surgical outcomes in many specialties, but remain scarcely applied in the vascular field. MethodsBased on the applied perioperative protocol in a single-center experience, three consecutive study groups were identified among 394 consecutive patients undergoing elective AAA open repair in the last 12 years. Group A included 66 patients who underwent traditional surgery, group B comprised 225 patients treated according to a partially adopted perioperative protocol, and group C consisted of 103 patients, operated in line with a complete perioperative protocol. The aim of this study was to evaluate the impact of the perioperative protocol on recovery time by measuring complication rates, analgesic and antiemetic control, and return of bowel function and ambulation, as well as the length of hospitalization. ResultsThe study groups had similar baseline characteristics. A significant improvement was noted in the complication rates (P = .019) and hospitalization time (P < .001) following a complete implementation of the perioperative protocol, where the median hospitalization time was 3 days. No mortality and no readmissions within 30 postoperative days were recorded in this group. There was an improvement in pain levels, as well as postoperative nausea and vomiting control (P < .001). ConclusionsPerioperative protocol implementation in AAA open repair is feasible; the clinical outcomes may be improved when strictly adhering to the protocol. All the applied perioperative management interventions seem to have a synergic effect on shortening the recovery time.

The New Challenge in the Management of Proximal Femur Fractures during SARS Cov-2 outbreak.

The aim of this study is to evaluate how the spread of Sars-Cov-2 has changed the epidemiology of proximal femur fractures in two major trauma centers in Italy, understanding the workload and the best allocation of the resources for the orthopedics department in such an emergency situation. The rate of patients from January 2019 to April 2020 hospitalized with femoral neck fractures (group A) and trochanteric fractures (group B) were recorded. Demographic data, timing of surgical treatment and the length of stay were recorded. Data show that the number of proximal femur fractures has remained unchanged in the COVID and pre-COVID era (ranging from an average of 91.14/month in the pre-COVID era to 76/month in March and 80/month in April). In our trauma centers, the rate of patients operated on within 48 hours has remained stable (78.19% vs 77.92%), while the length of stay has decreased during the COVID period (8.9 days vs 6.5 days in March and 6.8 days in April). Proximal femur fractures, even during the COVID period, are a constant issue and a new challenge for the healthcare system. The main goals of management are to preserve patients from viral infection, to provide early surgical treatment and fast track protocol for discharge.

Quality of Anaesthesiology Care in Postoperative Patients of Outpatient Surgery with Fast Track Protocol

Quality of Anaesthesiology Care in Postoperative Patients of Outpatient Surgery with Fast Track Protocol