Clinical outcomes and cost analysis of a "fast track" postoperative care pathway for ileal pouch-anal anastomosis. A case control study

Yehuda Kariv, Conor P. Delaney, Anthony J. Senagore, Elena A. Manilich, Jeffrey P. Hammel, James M. Church, Jeffrey Ravas, Victor W. Fazio

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

PURPOSE: Traditional length of hospital stay after ileal pouch-anal anastomosis is 8 to 15 days. Fast track rehabilitation programs reduce stay, but there are concerns that readmission and complication rates may be increased. This study evaluated a fast track pathway after ileoanal pouch surgery. METHODS: One hundred three consecutive patients underwent ileal pouch-anal anastomosis on two colorectal services using a fast track protocol with early ambulation, diet, and defined discharge criteria. Direct hospital costs and 30-day and long-term complication data were collected. Patients were matched to controls managed with traditional care pathways by other colorectal staff. RESULTS: Matching was established for 97 patients. Fast track patients had shorter hospital stay than controls (median 4 vs. 5 days; mean 5.0 vs. 5.9, P = 0.012). Readmission and recurrent operation rates were similar (24 vs. 20 percent, P = 0.49, and 9 vs. 10 percent, P = 0.8, fast track vs. control, respectively). Median direct costs per patient (US$) within 30 days were lower with fast track (5692 vs. 6672, P = 0.001), primarily because of reductions in postoperative management expenses. Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable. Early discharge (≤5 days from surgery) occurred in 79 (77 percent) fast track patients. Failure with early discharge was associated with male gender, reoperations, and anastomotic complications. CONCLUSIONS: Fast track protocol after ileoanal pouch surgery reduces length of stay and hospital costs without increasing complication rates. Successful early discharge usually signals a benign postoperative course.

Original languageEnglish (US)
Pages (from-to)137-146
Number of pages10
JournalDiseases of the Colon and Rectum
Volume50
Issue number2
DOIs
StatePublished - Feb 2007
Externally publishedYes

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Colonic Pouches
Postoperative Care
Case-Control Studies
Costs and Cost Analysis
Length of Stay
Hospital Costs
Pouchitis
Early Ambulation
Ambulatory Surgical Procedures
Reoperation
Pathologic Constriction
Rehabilitation
Diet

Keywords

  • Cost of care
  • Fast track
  • Ileal pouch-anal anastomosis
  • Length of stay
  • Postoperative care

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical outcomes and cost analysis of a "fast track" postoperative care pathway for ileal pouch-anal anastomosis. A case control study. / Kariv, Yehuda; Delaney, Conor P.; Senagore, Anthony J.; Manilich, Elena A.; Hammel, Jeffrey P.; Church, James M.; Ravas, Jeffrey; Fazio, Victor W.

In: Diseases of the Colon and Rectum, Vol. 50, No. 2, 02.2007, p. 137-146.

Research output: Contribution to journalArticle

Kariv, Yehuda ; Delaney, Conor P. ; Senagore, Anthony J. ; Manilich, Elena A. ; Hammel, Jeffrey P. ; Church, James M. ; Ravas, Jeffrey ; Fazio, Victor W. / Clinical outcomes and cost analysis of a "fast track" postoperative care pathway for ileal pouch-anal anastomosis. A case control study. In: Diseases of the Colon and Rectum. 2007 ; Vol. 50, No. 2. pp. 137-146.
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T1 - Clinical outcomes and cost analysis of a "fast track" postoperative care pathway for ileal pouch-anal anastomosis. A case control study

AU - Kariv, Yehuda

AU - Delaney, Conor P.

AU - Senagore, Anthony J.

AU - Manilich, Elena A.

AU - Hammel, Jeffrey P.

AU - Church, James M.

AU - Ravas, Jeffrey

AU - Fazio, Victor W.

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N2 - PURPOSE: Traditional length of hospital stay after ileal pouch-anal anastomosis is 8 to 15 days. Fast track rehabilitation programs reduce stay, but there are concerns that readmission and complication rates may be increased. This study evaluated a fast track pathway after ileoanal pouch surgery. METHODS: One hundred three consecutive patients underwent ileal pouch-anal anastomosis on two colorectal services using a fast track protocol with early ambulation, diet, and defined discharge criteria. Direct hospital costs and 30-day and long-term complication data were collected. Patients were matched to controls managed with traditional care pathways by other colorectal staff. RESULTS: Matching was established for 97 patients. Fast track patients had shorter hospital stay than controls (median 4 vs. 5 days; mean 5.0 vs. 5.9, P = 0.012). Readmission and recurrent operation rates were similar (24 vs. 20 percent, P = 0.49, and 9 vs. 10 percent, P = 0.8, fast track vs. control, respectively). Median direct costs per patient (US$) within 30 days were lower with fast track (5692 vs. 6672, P = 0.001), primarily because of reductions in postoperative management expenses. Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable. Early discharge (≤5 days from surgery) occurred in 79 (77 percent) fast track patients. Failure with early discharge was associated with male gender, reoperations, and anastomotic complications. CONCLUSIONS: Fast track protocol after ileoanal pouch surgery reduces length of stay and hospital costs without increasing complication rates. Successful early discharge usually signals a benign postoperative course.

AB - PURPOSE: Traditional length of hospital stay after ileal pouch-anal anastomosis is 8 to 15 days. Fast track rehabilitation programs reduce stay, but there are concerns that readmission and complication rates may be increased. This study evaluated a fast track pathway after ileoanal pouch surgery. METHODS: One hundred three consecutive patients underwent ileal pouch-anal anastomosis on two colorectal services using a fast track protocol with early ambulation, diet, and defined discharge criteria. Direct hospital costs and 30-day and long-term complication data were collected. Patients were matched to controls managed with traditional care pathways by other colorectal staff. RESULTS: Matching was established for 97 patients. Fast track patients had shorter hospital stay than controls (median 4 vs. 5 days; mean 5.0 vs. 5.9, P = 0.012). Readmission and recurrent operation rates were similar (24 vs. 20 percent, P = 0.49, and 9 vs. 10 percent, P = 0.8, fast track vs. control, respectively). Median direct costs per patient (US$) within 30 days were lower with fast track (5692 vs. 6672, P = 0.001), primarily because of reductions in postoperative management expenses. Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable. Early discharge (≤5 days from surgery) occurred in 79 (77 percent) fast track patients. Failure with early discharge was associated with male gender, reoperations, and anastomotic complications. CONCLUSIONS: Fast track protocol after ileoanal pouch surgery reduces length of stay and hospital costs without increasing complication rates. Successful early discharge usually signals a benign postoperative course.

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