Development and Extended Experience with a Fast Track Surgery Program in a Gynaecological Oncology Service

ABSTRACT

Introduction: Fast Track Surgery (FTS) programs combine a variety of techniques to optimise patient outcomes and as a consequence minimise length of stay.

Methods: An overview of the development of the FTS program at our hospital is followed by an audit of the experience of 3 full years of patients managed by FTS principles.

Results: Over the 3-year audit period, 251 patients were operated upon and managed by FTS principles. Seventy three in year 1, 99 in year 2 and 79 in year 3. Average age was 54, average weight 71.2 kg (Range 38-192kg) and average BMI 27.5 (Range 17-69). One hundred and thirty nine patients (55%) were considered overweight or obese. Two hundred and twenty seven patients (90%) were able to tolerate early oral feeding. Average operating time was 2.3 hours (range 1-10). Average EBL was 286 mL with average Hb change of 10.6g/L. Eight patients (3%) received intraoperative blood transfusions. Median LOS was 3 days. Fifty eight (23%) were discharged on day 2. ALOS was 3.8 days, slightly longer in malignant patients (4.1 days) compared to benign patients (3.4 days). Average LOS declined from 4.2 days in year 1 to 3.7 days in year 3. Eleven patients (4%) were readmitted. Complications were deemed acceptable based upon RANZCOG Quality Indicators.

Conclusions: Our extended experience confirms the feasibility and safety of undertaking a FTS program in patients with complex benign gynaecological pathology and gynaecological malignancy.

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