A Fast-track Pathway for Emergency General Surgery at an Academic Medical Center
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Authors
Fazzalari, AmandaSrinivas, Shruthi
Panjwani, Suraj
Pozzi, Natalie
Friedrich, Ann
Sheoran, Reeti
Sabato, Joseph
Durocher, Dawn
Reznek, Martin A.
Aiello, Francesco A.
Litwin, Demetrius E.
Cahan, Mitchell A.
UMass Chan Affiliations
Department of Surgery, Division of Vascular SurgeryDepartment of Emergency Medicine
Department of Surgery
Document Type
Journal ArticlePublication Date
2021-06-08Keywords
Acute appendicitisAcute cholecystitis
Emergency general surgery
Fast track
Emergency Medicine
Health and Medical Administration
Surgery
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BACKGROUND: Fast Track Pathways (FTP) directed at reducing length of stay (LOS) and overall costs are being increasingly implemented for emergency surgeries. The purpose of this study is to evaluate implementation of a FTP for Emergency General Surgery (EGS) at an academic medical center (AMC). METHODS: The study included 165 patients at an AMC between 2016 and 2018 who underwent laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), or laparoscopic inguinal hernia repair (LI). The FTP group enrolled 89 patients, and 76 controls prior to FTP implementation were evaluated. Time to surgery (TTS), LOS, and post-operative LOS between groups were compared. Direct costs, reimbursements, and patient reported satisfaction (satisfaction 1 = never, 4 = always) were also studied. RESULTS: The sample was 60.6% female, with a median age of 40 years. Case distribution differed slightly (56.2% versus 42.1% LA, 40.4% versus 57.9% LC, FTP versus control), but TTS was similar between groups (11h39min versus 10h02min, P = 0.633). LOS was significantly shorter in the FTP group (15h17min versus 29h09min, P < 0.001), reflected by shorter post-operative LOS (3h11min versus 20h10min, P < 0.001), fewer patients requiring a hospital bed and overnight stay (P < 0.001). Direct costs were significantly lower in the FTP group, reimbursements were similar (P < 0.001 and P = 0.999 respectively), and average patient reported satisfaction was good (3.3/4). CONCLUSION: In an era focused on decreasing cost, optimizing resources, and ensuring patient satisfaction, a FTP can play a significant role in EGS. At an AMC, an EGS FTP significantly decreased LOS, hospital bed utilization while not impacting reimbursement or patient satisfaction.Source
Fazzalari A, Srinivas S, Panjwani S, Pozzi N, Friedrich A, Sheoran R, Sabato J, Durocher D, Reznek M, Aiello F, Litwin D, Cahan MA. A Fast-track Pathway for Emergency General Surgery at an Academic Medical Center. J Surg Res. 2021 Jun 8;267:1-8. doi: 10.1016/j.jss.2021.04.012. Epub ahead of print. PMID: 34116389. Link to article on publisher's site
DOI
10.1016/j.jss.2021.04.012Permanent Link to this Item
http://hdl.handle.net/20.500.14038/29850PubMed ID
34116389Related Resources
ae974a485f413a2113503eed53cd6c53
10.1016/j.jss.2021.04.012