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World Journal of Surgery

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01-04-2016 | Original Scientific Report

Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies

Authors: Colleen M. Trevino, Karina M. Katchko, Amy L. Verhaalen, Marie L. Bruce, Travis P. Webb

Published in: World Journal of Surgery | Issue 4/2016

Abstract

Background

Fast-track protocols (FTPs) are used to decrease length of stay (LOS) and hospital costs for elective outpatient procedures. Few institutions have implemented FTP for urgent procedures such as laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA).

Study design

This is a retrospective single-institution cohort study including all patients undergoing urgent LC or LA between July 1, 2010 and May 1, 2013. Exclusion criteria included conversion to open procedure, perforated appendicitis, or procedure related to intra-abdominal injury. Analysis included a comparison of the three study groups: (1) before (PRE) and after (POST) implementation of the fast-track protocol (FTP), (2) fast-track cohort (FT) and non-fast-track cohort (NFT), and (3) those completing the fast-track pathway (FT-C) and those who began but failed to complete the pathway (FT-F).

Results

There were significant reductions in LOS between all study groups compared: between PRE (n = 256) and POST (n = 472) cohorts by half a day (2.0 vs. 1.5 days, p < 0.02); between FT and NFT (0.68 vs. 1.82 days, p < 0.01); and FT-C and FT-F (0.49 vs. 1.05 days, p < 0.01). Total hospital charges were significantly reduced in FT compared with NFT ($22,347 vs. $30,868, p < 0.01) with an average savings of $8521. Total hospital charges were decreased in the FT-C compared with FT-F cohorts ($21,971 vs. $22,939, p = 0.3) with an average savings of $968. Readmissions, complications, and satisfaction were similar for all comparison groups.

Conclusions

FTPs for urgent appendectomies and cholecystectomies can significantly reduce hospital costs by reducing LOS without compromising patient outcomes.

Committee to Develop the Reorganized Specialty of Trauma SCC, and Emergency Surgery (2005) Acute care surgery: trauma, critical care, and emergency surgery. J Trauma 58:614–615CrossRef

Weissman C, Klein N (2008) The importance of differentiating between elective and emergency postoperative critical care patients. J Crit Care 23:308–316CrossRefPubMed

Becher RD, Hoth JJ, Miller PR et al (2011) A critical assessment of outcomes in emergency general surgery using the American College of Surgeons National Surgical Quality Improvement Program Database. Am Surg 77:951–959PubMed

Becher RD, Meredith JW, Chang MC et al (2012) Creation and implementation of an emergency general surgery registry modeled after the national trauma data bank. J Am Coll Surg 214:156–163CrossRefPubMed

Giller U, Hervey S, Purves H, Muhlbaier LH, Peterson ED, Eubanks S, Pietrobon R (2004) Laparoscopic versus open appendectomy. Ann Surg 239:43–52CrossRef

Kulvatunyou N, Joseph B, Gries L et al (2012) A prospective cohort study of 200 acute care gallbladder surgeries: the same disease but a different approach. J Trauma Acute Care Surg 73:1039–1045CrossRefPubMed

Lehane CW, Jootun RN, Bennett M et al (2010) Does an acute care surgery model improve the management and outcome of acute cholecystitis? ANZ J Surg 80:438–442CrossRefPubMed

Gilliam AD, Anand R, Horgan LF, Attwood SE (2008) Day case emergency laparoscopic appendectomy. Surg Endosc 22(2):483–486CrossRefPubMed

Dubois L, Vogt KN, Davies W, Schlachta CM (2010) Impact of an outpatient appendectomy protocol on clinical outcomes and cost: a case control study. J Am Col Surg 211:731–737CrossRef

10.

Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast track surgery. Ann Surg 248:189–198CrossRefPubMed

11.

Carter J, Szabo R, Sim WW et al (2010) Fast track surgery: a clinical audit. Aust N Z J Obstet Gynaecol 50:159–163CrossRefPubMed

12.

Frazee RC, Roberts JW, Symmonds RE et al (1994) A prospective randomized trial comparing open versus laparoscopic appendectomy. Ann Surg 219:725–728PubMedCentralCrossRefPubMed

13.

Calland JF, Tanaka K, Foley E et al (2001) Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway. Ann Surg 233:704–715PubMedCentralCrossRefPubMed

14.

Cash CL, Frazee RC, Abernathy SW et al (2012) A prospective treatment protocol for outpatient laparoscopic appendectomy for acute appendicitis. J Am Coll Surg 215:101–106CrossRefPubMed

15.

Wenner DE, Whitwam P, Turner D et al (2006) Laparoscopic cholecystectomy and management of biliary tract stones in a freestanding ambulatory surgery center. JSLS 10:47–51PubMedCentralPubMed

16.

Ahmad NZ, Byrnes G, Naqvi SA (2008) A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endo 22:1928–1934CrossRef

17.

Lillemoe KD, Lin JW, Talamini MA et al (1999) Laparoscopic cholecystectomy as a true outpatient procedure: initial experience in 130 consecutive patients. J Gastrointest Surg 3:44–49CrossRefPubMed

18.

Parvaiz MA, Hafeez R (2006) Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg 93:639–640CrossRefPubMed

19.

Kasem A, Paix A, Grandy-Smith S, El-Hasani S (2006) Is laparoscopic cholecystectomy safe and acceptable as a day case procedure? J Laparoendosc Adv Surg Tech A 16:365–368CrossRefPubMed

20.

Jakobsen DH, Sonne E, Kehlet H (2006) Nursing workload and fast track colonic surgery. J Adv Perioper Care 2:177–181

21.

Turner LJ (1995) Putting patient education on a new path. RN 58:42–44PubMed

22.

Bisgaard T (2006) Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 104:835–846CrossRefPubMed

23.

Strasberg S (2008) Acute calculous cholecystitis. NEJM 358:2804–2811CrossRefPubMed

24.

Mason RJ (2008) Surgery for appendicitis: is it necessary? Surg Infect 9(4):481–488CrossRef

25.

Lim SH, Jang EH, Kim MH et al (2011) Analgesic effect of preoperative versus intraoperative dexamethasone after laparoscopic cholecystectomy with multimodal analgesia. Korean J Anesthesiol 61:315–319PubMedCentralCrossRefPubMed

26.

Wills VL, Hunt DR (2000) Pain after cholecystectomy. Br J Surg 87:273–284CrossRefPubMed

27.

Michaloliakou C, Chung F, Sharma S (1996) Postoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 82:44–51PubMed

28.

Acalovschi I (2002) Postoperative nausea and vomiting. Curr Anaesth Crit Care 13:37–43CrossRef

29.

Helmy SA (1999) Prophylactic anti-emetic efficacy of ondansetron in laparoscopic cholecystectomy under total intravenous anesthesia. Anesthesia 54:266–271CrossRef

30.

Naguib M, Bakry AK, Khoshim MH et al (1996) Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth 43:226–231CrossRefPubMed

31.

Cekmen N, Akcabay M, Mahli A, Arslan M (2003) Comparison of the effects of dexamethasone and metoclopramide on postoperative nausea and vomiting. Erciyes Med J 25:137–143

Title: Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies
Authors: Colleen M. Trevino
Karina M. Katchko
Amy L. Verhaalen
Marie L. Bruce
Travis P. Webb
Publication date: 01-04-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 4/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3266-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies

Abstract

Background

Study design

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Study design

Results

Conclusions

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