Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies. World J Surg 2016 Apr;40(4):856-62
Date
10/17/2015Pubmed ID
26470696DOI
10.1007/s00268-015-3266-3Scopus ID
2-s2.0-84959529489 (requires institutional sign-in at Scopus site) 30 CitationsAbstract
BACKGROUND: Fast-track protocols (FTPs) are used to decrease length of stay (LOS) and hospital costs for elective outpatient procedures. Few institutions have implemented FTP for urgent procedures such as laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA).
STUDY DESIGN: This is a retrospective single-institution cohort study including all patients undergoing urgent LC or LA between July 1, 2010 and May 1, 2013. Exclusion criteria included conversion to open procedure, perforated appendicitis, or procedure related to intra-abdominal injury. Analysis included a comparison of the three study groups: (1) before (PRE) and after (POST) implementation of the fast-track protocol (FTP), (2) fast-track cohort (FT) and non-fast-track cohort (NFT), and (3) those completing the fast-track pathway (FT-C) and those who began but failed to complete the pathway (FT-F).
RESULTS: There were significant reductions in LOS between all study groups compared: between PRE (n = 256) and POST (n = 472) cohorts by half a day (2.0 vs. 1.5 days, p < 0.02); between FT and NFT (0.68 vs. 1.82 days, p < 0.01); and FT-C and FT-F (0.49 vs. 1.05 days, p < 0.01). Total hospital charges were significantly reduced in FT compared with NFT ($22,347 vs. $30,868, p < 0.01) with an average savings of $8521. Total hospital charges were decreased in the FT-C compared with FT-F cohorts ($21,971 vs. $22,939, p = 0.3) with an average savings of $968. Readmissions, complications, and satisfaction were similar for all comparison groups.
CONCLUSIONS: FTPs for urgent appendectomies and cholecystectomies can significantly reduce hospital costs by reducing LOS without compromising patient outcomes.
Author List
Trevino CM, Katchko KM, Verhaalen AL, Bruce ML, Webb TPAuthor
Colleen Trevino PhD Assoc Professor Clinical Dir Inpatient 2 in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAppendectomy
Appendicitis
Cholecystectomy, Laparoscopic
Cholecystitis, Acute
Clinical Protocols
Cohort Studies
Cost-Benefit Analysis
Female
Historically Controlled Study
Hospital Charges
Hospital Costs
Humans
Laparoscopy
Length of Stay
Male
Retrospective Studies
United States