AUTHOR=Lambat Emery Shahzia , Brossard Philippe , Petignat Patrick , Boulvain Michel , Pluchino Nicola , Dällenbach Patrick , Wenger Jean-Marie , Savoldelli Georges L. , Rehberg-Klug Benno , Dubuisson Jean 

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

JOURNAL=Frontiers in Surgery

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2021.773653

DOI=10.3389/fsurg.2021.773653

ISSN=2296-875X

ABSTRACT=<p><bold>Study Objective:</bold> Evaluate the effects of a fast-track (FT) protocol on costs and post-operative recovery.</p><p><bold>Methods:</bold> 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.</p><p><bold>Main Results:</bold> 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 (<italic>p</italic> = 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 (<italic>p</italic> = 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 (<italic>p</italic> = 0.57)]. Satisfaction with medical follow-up 1 month after surgery was also similar [91% in FT and 88% in the usual care group (<italic>p</italic> = 0.69)].</p><p><bold>Conclusion:</bold> 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.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>, identifier: NCT04839263.</p>