Jonathan Carter1,2, Shannon Philp3,4,5, King M Wan3. 1. Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia. jonathan.carter@lh.org.au. 2. The University of Sydney, Sydney, New South Wales, Australia. jonathan.carter@lh.org.au. 3. Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia. 4. The University of Sydney, Sydney, New South Wales, Australia. 5. Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: Fast track surgery (FTS) programs minimise the stress response after surgery and allow for enhanced recovery. AIMS: To document the frequency and incidence of adverse events in patients enrolled on a FTS program and to investigate factors associated with shorter length of stay and readmission to hospital. METHODS: A seven-year updated surgical audit of patients undergoing laparotomy for suspected or confirmed malignancy on a FTS program. RESULTS: Five hundred and fifty patients comprise the study group. Average age and body mass index (BMI) were 55 years and 28, respectively. Mean length of stay (LOS) was 3.4 days with 194 (35%) patients discharged on day 2. Six (1%) patients had confirmed venous thromboembolism (VTE), three of whom were diagnosed on pre-operative imaging. Overall, transfusion rate was 5%. Adverse events in decreasing frequency were hospital readmission (4%) and significant wound infection (3%). All other adverse events were uncommon with rates <0.5%. Factors associated with a discharge on or after day 3 include age, pathology, Eastern Cooperative Oncology Group performance status, incision type, operating time, blood transfusion and cyclo-oxygenase 2 inhibitors. Factors associated with hospital readmission include longer operating time, performance of lymph node sampling/dissection, longer LOS, development of wound infection, febrile morbidity, return to the operating room, unplanned intensive care unit admission and presence of other complications. CONCLUSIONS: Patients managed by a FTS protocol can expect enhanced outcomes when compared to historical controls.
BACKGROUND: Fast track surgery (FTS) programs minimise the stress response after surgery and allow for enhanced recovery. AIMS: To document the frequency and incidence of adverse events in patients enrolled on a FTS program and to investigate factors associated with shorter length of stay and readmission to hospital. METHODS: A seven-year updated surgical audit of patients undergoing laparotomy for suspected or confirmed malignancy on a FTS program. RESULTS: Five hundred and fifty patients comprise the study group. Average age and body mass index (BMI) were 55 years and 28, respectively. Mean length of stay (LOS) was 3.4 days with 194 (35%) patients discharged on day 2. Six (1%) patients had confirmed venous thromboembolism (VTE), three of whom were diagnosed on pre-operative imaging. Overall, transfusion rate was 5%. Adverse events in decreasing frequency were hospital readmission (4%) and significant wound infection (3%). All other adverse events were uncommon with rates <0.5%. Factors associated with a discharge on or after day 3 include age, pathology, Eastern Cooperative Oncology Group performance status, incision type, operating time, blood transfusion and cyclo-oxygenase 2 inhibitors. Factors associated with hospital readmission include longer operating time, performance of lymph node sampling/dissection, longer LOS, development of wound infection, febrile morbidity, return to the operating room, unplanned intensive care unit admission and presence of other complications. CONCLUSIONS:Patients managed by a FTS protocol can expect enhanced outcomes when compared to historical controls.
Authors: Katiuscha Merath; Fabio Bagante; Qinyu Chen; Eliza W Beal; Ozgur Akgul; Jay Idrees; Mary Dillhoff; Jordan Cloyd; Carl Schmidt; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2018-05-07 Impact factor: 3.452