title: Implementation of a fast-track-pathway including analgo-sedation with local anaesthesia for outpatient varicose vein surgery: a cohort study.
abstract: OBJECTIVE
  To evaluate the clinical and economical impact of a fast-track anaesthesia protocol in the management of primary varicose vein (VV) surgery.
  
  
  METHODS
  Over a 10-month period (from 1 December 2009 to 30 September 2011), all patients eligible for open VV surgery (N = 176) were enrolled in a fast-track clinical pathway including titrated analgo-sedation combined with local anaesthesia. This fast-track cohort was compared with a historical cohort undergoing similar procedures and receiving general anaesthesia (GA) or spinal anaesthesia (SA) (between 1 December 2009 to 30 September 2011, N = 200). The length of stay in the operating facilities and postoperative recovery areas were reported and hospital costs were estimated. In addition, the occurrence of adverse events and unplanned hospital admission were compared between the two consecutive periods.
  
  
  RESULTS
  Patients characteristics and surgical procedure were not different in the two cohorts. After implementation of the fast-track pathway, the incidence of postoperative adverse events decreased from 41% to 2.3%, with no need for overnight hospital stay (0% versus 7%). The reduction in anaesthesia-controlled time (-47%) and in postoperative recovery time (-61%) were associated with an increased operating capacity (1 extra case per day) and with substantial cost-savings (mean reduction of €312 per case, P < 0.001).
  
  
  CONCLUSIONS
  Implementation of a fast-track pathway for outpatient VV surgery was successful, safe and efficient. Analgo-sedation combined with infiltrative anaesthesia (instead of GA or SA) contributed to increase the operating capacity and to reduce the workload of nursing personnel.
authors.affiliation: Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva.
authors.forename: M
authors.initials: M
authors.lastname: Licker
authors.forename: E
authors.initials: E
authors.lastname: Brandao-Farinelli
authors.forename: V
authors.initials: V
authors.lastname: Cartier
authors.forename: G
authors.initials: G
authors.lastname: Gemayel
authors.forename: J T
authors.initials: JT
authors.lastname: Christenson
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016292:Procedural Sedation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D014648:Varicose Veins / Q000191:economics / Q000601:surgery*