Optimising recovery after surgery: Predictors of early discharge and hospital readmission.
BACKGROUND
Fast track surgery (FTS) programs minimise the stress response after surgery and allow for enhanced recovery.


OBJECTIVE
To document the frequency and incidence of adverse events in patients enrolled on a FTS program and to investigate factors associated with shorter length of stay and readmission to hospital.


METHODS
A seven-year updated surgical audit of patients undergoing laparotomy for suspected or confirmed malignancy on a FTS program.


RESULTS
Five hundred and fifty patients comprise the study group. Average age and body mass index (BMI) were 55 years and 28, respectively. Mean length of stay (LOS) was 3.4 days with 194 (35%) patients discharged on day 2. Six (1%) patients had confirmed venous thromboembolism (VTE), three of whom were diagnosed on pre-operative imaging. Overall, transfusion rate was 5%. Adverse events in decreasing frequency were hospital readmission (4%) and significant wound infection (3%). All other adverse events were uncommon with rates <0.5%. Factors associated with a discharge on or after day 3 include age, pathology, Eastern Cooperative Oncology Group performance status, incision type, operating time, blood transfusion and cyclo-oxygenase 2 inhibitors. Factors associated with hospital readmission include longer operating time, performance of lymph node sampling/dissection, longer LOS, development of wound infection, febrile morbidity, return to the operating room, unplanned intensive care unit admission and presence of other complications.


CONCLUSIONS
Patients managed by a FTS protocol can expect enhanced outcomes when compared to historical controls.
Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia. jonathan.carter@lh.org.au.|The University of Sydney, Sydney, New South Wales, Australia. jonathan.carter@lh.org.au.
Jonathan
J
Carter
Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.|The University of Sydney, Sydney, New South Wales, Australia.|Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia.
Shannon
S
Philp
Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
King M
KM
Wan
D000328:Adult; D000367:Age Factors; D000368:Aged; D001803:Blood Transfusion; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D061646:Operative Time; D010351:Patient Discharge; D010359:Patient Readmission; D012086:Reoperation; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D054556:Venous Thromboembolism / Q000209:etiology
enhanced recovery after surgery; fast track surgery