Clinical outcomes and cost analysis of a "fast track" postoperative care pathway for ileal pouch-anal anastomosis: a case control study.
OBJECTIVE
Traditional length of hospital stay after ileal pouch-anal anastomosis is 8 to 15 days. Fast track rehabilitation programs reduce stay, but there are concerns that readmission and complication rates may be increased. This study evaluated a fast track pathway after ileoanal pouch surgery.


METHODS
One hundred three consecutive patients underwent ileal pouch-anal anastomosis on two colorectal services using a fast track protocol with early ambulation, diet, and defined discharge criteria. Direct hospital costs and 30-day and long-term complication data were collected. Patients were matched to controls managed with traditional care pathways by other colorectal staff.


RESULTS
Matching was established for 97 patients. Fast track patients had shorter hospital stay than controls (median 4 vs. 5 days; mean 5.0 vs. 5.9, P = 0.012). Readmission and recurrent operation rates were similar (24 vs. 20 percent, P = 0.49, and 9 vs. 10 percent, P = 0.8, fast track vs. control, respectively). Median direct costs per patient (US$) within 30 days were lower with fast track (5692 vs. 6672, P = 0.001), primarily because of reductions in postoperative management expenses. Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable. Early discharge (< or = 5 days from surgery) occurred in 79 (77 percent) fast track patients. Failure with early discharge was associated with male gender, reoperations, and anastomotic complications.


CONCLUSIONS
Fast track protocol after ileoanal pouch surgery reduces length of stay and hospital costs without increasing complication rates. Successful early discharge usually signals a benign postoperative course.
Kariv
Yehuda
Y
Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Delaney
Conor P
CP
Senagore
Anthony J
AJ
Manilich
Elena A
EA
Hammel
Jeffrey P
JP
Church
James M
JM
Ravas
Jeffrey
J
Fazio
Victor W
VW
D000328:Adult; D000714:Anastomosis, Surgical / Q000191:economics; D016022:Case-Control Studies; D039021:Colonic Pouches / Q000191:economics*; D003365:Costs and Cost Analysis; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007081:Ileostomy; D007902:Length of Stay / Q000191:economics*; D008297:Male; D011182:Postoperative Care / Q000191:economics* / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics; D018709:Statistics, Nonparametric; D016896:Treatment Outcome