Lambat Emery Shahzia, Brossard Philippe, Petignat Patrick, Boulvain Michel, Pluchino Nicola, Dällenbach Patrick, Wenger Jean-Marie, Savoldelli Georges L, Rehberg-Klug Benno, Dubuisson Jean
Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
University of Geneva, Geneva, Switzerland.
Front Surg. 2021 Nov 11;8:773653. doi: 10.3389/fsurg.2021.773653. eCollection 2021.
Evaluate the effects of a fast-track (FT) protocol on costs and post-operative recovery. 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. 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 ( = 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 ( = 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 ( = 0.57)]. Satisfaction with medical follow-up 1 month after surgery was also similar [91% in FT and 88% in the usual care group ( = 0.69)]. 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. www.ClinicalTrials.gov, identifier: NCT04839263.
评估快速康复（FT）方案对成本和术后恢复的影响。170名因良性指征接受全腹腔镜子宫切除术的女性被随机分为FT方案组或常规护理方案组。FT方案包括微创手术、优化镇痛、早期经口进食和患者快速活动，将其与常规护理方案进行比较。主要结局是成本。次要结局是住院时间、术后发病率和患者满意度。FT组每位患者的平均总成本为13,070±4,321欧元（EUR），常规护理组高出3.5%，为13,527±3,925欧元（P = 0.49）。FT组住院手术成本较低，但术后第一个月的门诊总成本较高。FT组的平均住院时间为52.7±26.8小时，常规护理组高出20%，为65.8±33.7小时（P = 0.006）。两组术后第一个月的发病率无显著差异。出院当天，两组对疼痛管理满意的患者比例相似[FT组为83%，常规护理组为78%（P = 0.57）]。术后1个月对医疗随访的满意度也相似[FT组为91%，常规护理组为88%（P = 0.69）]。对良性指征的腹腔镜子宫切除术实施FT方案对成本影响极小且无统计学意义，但显著缩短了住院时间，且未增加术后发病率，也未降低患者满意度。ClinicalTrials.gov网站，标识符：NCT04839263。
