University of Massachusetts Medical School Faculty Publications

Title

A Fast-track Pathway for Emergency General Surgery at an Academic Medical Center

UMMS Affiliation

Department of Surgery; Department of Emergency Medicine; Department of Surgery, Division of Vascular Surgery

Publication Date

2021-06-08

Document Type

Article

Disciplines

Emergency Medicine | Health and Medical Administration | Surgery

Abstract

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.

Keywords

Acute appendicitis, Acute cholecystitis, Emergency general surgery, Fast track

DOI of Published Version

10.1016/j.jss.2021.04.012

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

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

The Journal of surgical research

PubMed ID

34116389

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