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.
Dr Yehuda Kariv and Ohio evaluated a fast track pathway after ileoanal pouch surgery.
The research team investigated 103 consecutive patients.
The patients underwent ileal pouch-anal anastomosis on 2 colorectal services.
|Early discharge occurred in 77% of fast track patients|
|Diseases of the Colon & Rectum|
The team used a fast track protocol with early ambulation, diet, and defined discharge criteria.
The researchers collected direct hospital costs, 30-day and long-term complication data.
Patients were matched to controls managed with traditional care pathways by other colorectal staff.
Matching was established for 97 patients.
Fast track patients had shorter hospital stay than controls.
The researchers found that readmission and recurrent operation rates were similar.
Median direct costs per patient within 30 days were lower with fast track.
The team noted that this was primarily because of reductions in postoperative management expenses.
Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable.
The researchers observed that early discharge occurred in 77% of fast track patients.
Failure with early discharge was associated with male gender, reoperations, and anastomotic complications.
Dr Kariv's team concludes, “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.”