title: Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies.
abstract: 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).
  
  
  METHODS
  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.
authors.affiliation: Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. ctrevino@mcw.edu.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Trevino
authors.affiliation: Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. kkatchko@mcw.edu.
authors.forename: Karina M
authors.initials: KM
authors.lastname: Katchko
authors.affiliation: Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. averhaal@mcw.edu.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Verhaalen
authors.affiliation: Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. mbruce@mcw.edu.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Bruce
authors.affiliation: Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. trwebb@mcw.edu.
authors.forename: Travis P
authors.initials: TP
authors.lastname: Webb
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000191:economics / Q000379:methods*; D001064:Appendicitis / Q000191:economics / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D041881:Cholecystitis, Acute / Q000191:economics / Q000601:surgery*; D002985:Clinical Protocols; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D065386:Historically Controlled Study; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D014481:United States