title: Does fast-tracking increase the readmission rate after pulmonary resection? A case-matched study.
abstract: OBJECTIVE
  The most recent evolution of patient management after thoracic surgery implies the concept of fast-tracking. Since 2008, our unit has implemented a programme based on clinical protocols and standardized pathways of care aimed to reduce the postoperative stay after major lung resection. The objective of this study was to verify the safety of this policy by monitoring the patient readmission rate.
  
  
  METHODS
  This is a prospective observational study on 914 consecutive pulmonary lobectomies performed at our institution from January 2000 to October 2010. Since we started the fast-tracking program in January 2008, we divided the patients into two groups: early period (678 patients, 2000-2007) and recent period (236 patients, 2008-October 2010). Several baseline and operative factors were used to build a propensity score that was applied to match the recent group patients with their early group counterparts. These two matched groups were then compared in terms of early outcomes and readmission rate. Readmission was defined as a re-hospitalization for any cause related to the operation within 30 days after discharge. We excluded from the analysis those patients with in-hospital mortality.
  
  
  RESULTS
  Propensity score yielded 232 well-matched pairs operated on in the early (non-fast-tracked patients) and most recent period (fast-tracked patients). The fast-tracking management resulted in a postoperative stay reduction of 2.8 days (P < 0.0001), with a 3-fold higher proportion of patients discharged before the sixth postoperative day (P < 0.0001). Nevertheless, we did not observe any differences in terms of readmission rate between the two periods.
  
  
  CONCLUSIONS
  In our experience, the implementation of a fast-tracking program after pulmonary lobectomy was very effective and safe. It led to a postoperative reduction of hospital stay without an increase in the readmission rate.
authors.affiliation: Unit of Thoracic Surgery, United Hospitals Ancona, Ancona, Italy. michelesalati@hotmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Xiumè
authors.forename: Majed
authors.initials: M
authors.lastname: Refai
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pompili
authors.forename: Armando
authors.initials: A
authors.lastname: Sabbatini
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011013:Pneumonectomy / Q000009:adverse effects*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D015397:Program Evaluation; D012189:Retrospective Studies; D016896:Treatment Outcome