Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes

Study Objective: Evaluate the effects of a fast-track (FT) protocol on costs and post-operative recovery.Methods: One hundred and seventy women undergoing total laparoscopic hysterectomy for a benign indication were randomized in a FT protocol or a usual care protocol. A FT protocol included the com...

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Autores principales:	Shahzia Lambat Emery, Philippe Brossard, Patrick Petignat, Michel Boulvain, Nicola Pluchino, Patrick Dällenbach, Jean-Marie Wenger, Georges L. Savoldelli, Benno Rehberg-Klug, Jean Dubuisson
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	fast-track laparoscopic hysterectomy (LH) hospital costs hospital stay pain assessment post-operative morbidity Surgery RD1-811
Acceso en línea:	https://doaj.org/article/ddb5ada96f40409d995116e5dcb3ff60
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spelling	oai:doaj.org-article:ddb5ada96f40409d995116e5dcb3ff602021-11-11T08:56:32ZFast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes2296-875X10.3389/fsurg.2021.773653https://doaj.org/article/ddb5ada96f40409d995116e5dcb3ff602021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fsurg.2021.773653/fullhttps://doaj.org/toc/2296-875XStudy Objective: Evaluate the effects of a fast-track (FT) protocol on costs and post-operative recovery.Methods: One hundred and seventy women undergoing total laparoscopic hysterectomy for a benign indication were randomized in a FT protocol or a usual care protocol. 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. Primary outcome was costs. Secondary outcomes were length of stay, post-operative morbidity and patient satisfaction.Main Results: The mean total cost in the FT group was 13,070 ± 4,321 Euros (EUR) per patient, and that in the usual care group was 3.5% higher at 13,527 ± 3,925 EUR (p = 0.49). The FT group had lower inpatient surgical costs but higher total ambulatory costs during the first post-operative month. The mean hospital stay in the FT group was 52.7 ± 26.8 h, and that in the usual care group was 20% higher at 65.8 ± 33.7 h (p = 0.006). Morbidity during the first post-operative month was not significantly different between the two groups. On their day of discharge, the proportion of patients satisfied with pain management was similar in both groups [83% in FT and 78% in the usual care group (p = 0.57)]. Satisfaction with medical follow-up 1 month after surgery was also similar [91% in FT and 88% in the usual care group (p = 0.69)].Conclusion: Implementation of a FT protocol in laparoscopic hysterectomy for benign indications has minimal non-significant effects on costs but significantly reduces hospital stay without increasing post-operative morbidity nor decreasing patient satisfaction.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04839263.Shahzia Lambat EmeryPhilippe BrossardPatrick PetignatMichel BoulvainNicola PluchinoPatrick DällenbachJean-Marie WengerGeorges L. SavoldelliBenno Rehberg-KlugJean DubuissonFrontiers Media S.A.articlefast-tracklaparoscopic hysterectomy (LH)hospital costshospital staypain assessmentpost-operative morbiditySurgeryRD1-811ENFrontiers in Surgery, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	fast-track laparoscopic hysterectomy (LH) hospital costs hospital stay pain assessment post-operative morbidity Surgery RD1-811
spellingShingle	fast-track laparoscopic hysterectomy (LH) hospital costs hospital stay pain assessment post-operative morbidity Surgery RD1-811 Shahzia Lambat Emery Philippe Brossard Patrick Petignat Michel Boulvain Nicola Pluchino Patrick Dällenbach Jean-Marie Wenger Georges L. Savoldelli Benno Rehberg-Klug Jean Dubuisson Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes
description	Study Objective: Evaluate the effects of a fast-track (FT) protocol on costs and post-operative recovery.Methods: One hundred and seventy women undergoing total laparoscopic hysterectomy for a benign indication were randomized in a FT protocol or a usual care protocol. 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. Primary outcome was costs. Secondary outcomes were length of stay, post-operative morbidity and patient satisfaction.Main Results: The mean total cost in the FT group was 13,070 ± 4,321 Euros (EUR) per patient, and that in the usual care group was 3.5% higher at 13,527 ± 3,925 EUR (p = 0.49). The FT group had lower inpatient surgical costs but higher total ambulatory costs during the first post-operative month. The mean hospital stay in the FT group was 52.7 ± 26.8 h, and that in the usual care group was 20% higher at 65.8 ± 33.7 h (p = 0.006). Morbidity during the first post-operative month was not significantly different between the two groups. On their day of discharge, the proportion of patients satisfied with pain management was similar in both groups [83% in FT and 78% in the usual care group (p = 0.57)]. Satisfaction with medical follow-up 1 month after surgery was also similar [91% in FT and 88% in the usual care group (p = 0.69)].Conclusion: Implementation of a FT protocol in laparoscopic hysterectomy for benign indications has minimal non-significant effects on costs but significantly reduces hospital stay without increasing post-operative morbidity nor decreasing patient satisfaction.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04839263.
format	article
author	Shahzia Lambat Emery Philippe Brossard Patrick Petignat Michel Boulvain Nicola Pluchino Patrick Dällenbach Jean-Marie Wenger Georges L. Savoldelli Benno Rehberg-Klug Jean Dubuisson
author_facet	Shahzia Lambat Emery Philippe Brossard Patrick Petignat Michel Boulvain Nicola Pluchino Patrick Dällenbach Jean-Marie Wenger Georges L. Savoldelli Benno Rehberg-Klug Jean Dubuisson
author_sort	Shahzia Lambat Emery
title	Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes
title_short	Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes
title_full	Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes
title_fullStr	Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes
title_full_unstemmed	Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes
title_sort	fast-track in minimally invasive gynecology: a randomized trial comparing costs and clinical outcomes
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/ddb5ada96f40409d995116e5dcb3ff60
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Fast-Track in Minimally Invasive Gynecology: A Randomized Trial Comparing Costs and Clinical Outcomes

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