Objective: Evaluate the effects of a fast-track (FT) protocol on costs and postoperative recovery. Design: randomized trial Setting: University Hospitals Population: 170 women undergoing total laparoscopic hysterectomy for a benign indication Methods: A FT protocol included the combination of minimally invasive surgery, analgesia optimization, early oral refeeding and rapid mobilization of patients was compared to a usual care protocol. Main outcomes measure: Primary outcome was costs. Secondary outcomes were length of stay, postoperative morbidity and patient satisfaction.
1. Fast-Track protocol: Preoperative * Anesthetic consultation * Proposal of optimization of patient's general health state + family meeting if necessary * Hospitalization on day of surgery * Solids stopped 6 hours prior to surgery, drinking encouraged up to 2 hours prior to surgery During surgery * Anti-infectious prophylaxis * Anesthesia via IV propofol/remifentanil * Anti-nausea prophylaxis * Pain control based on limited systemic opioid use Postoperative * Balanced analgesia for pain control * Antithrombotic prophylaxis * Early oral refeeding * Rapid mobilization * Gum chewing * Foley catheter removal at the end of surgery * Peripheral IV catheter removal 6 hours postoperatively 2. Usual care protocol : Preoperative * Anesthetic consultation * Hospitalization on day of surgery * Fasting beginning at midnight prior to surgery During surgery * Anti-infectious prophylaxis * Balanced anesthesia via halogen gas * Anti-nausea medication if needed Postoperative * Balanced analgesia for pain control * Antithrombotic prophylaxis * Same-day refeeding according to patient's wish * Same-day mobilization according to patient's wish * Foley and peripheral IV catheter removal on day 1 postoperatively
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
Preoperative evaluation and information Patient general health state optimization proposal prior to hospitalization: Preoperative strategy: * Hospitalization on surgery day * No prolonged fasting Perioperative strategy: * Pain control based on limited systemic opioid therapy use * Anti-nausea prophylaxis * Anaesthesia via IV propofol / remifentanyl * Bladder catheter removal postoperative Postoperative strategy: * Pain control using balanced analgesia * Gum chewing * Early oral refeeding and rapid mobilization * Venflon removal 6 hours post-op
HUG
Geneva, Switzerland
University Hospitals
Geneva, Switzerland
Hospital costs and ambulatory costs
The economic evaluation covered hospital inpatient surgical care costs and ambulatory costs. Resource inputs were divided into two main categories: (1) hospital inpatient surgical costs and (2) ambulatory costs further divided into (2a) hospital-related costs (A\&E Department consultations and hospital readmission) and (2b) community costs (community health + social costs and caregiver's loss of production costs). Hospital costs were collected using a computerized hospital information system developed by the University Hospitals of Geneva. The patients recorded community costs in a logbook containing the community health and social invoices and caregivers' number of absent working days. Caregivers' loss of production was extrapolated via Switzerland's median wage per working day.
Time frame: Up to 1 month postoperative
Hospital length of stay
Hospital stay was retrieved from the computerized patient record
Time frame: Up to 1 month postoperative
Postoperative morbidity rate during the first postoperative month
Morbidity during the first postoperative month was monitored via patient consultations at the Accident and Emergency (A\&E) Department
Time frame: Up to 1 month postoperative
Satisfaction assessed by a three-point likert scale
Patient satisfaction was evaluated on their day of discharge and at their 1-month postoperative follow-up visit based on a three-point likert scale regarding their satisfaction with the care they received. The likert scale ranged from 0 (unsatisfied) to 2 (satisfied).
Time frame: Up to 1 month postoperative
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