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

Carter, Jonathan

doi:10.2174/1874291201105010022

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…2010a,b; Pather et al . , ; Carter & Philp ). The current study supports a high level of satisfaction for nurse, doctor and hospital services around gynaecological patients' own experiences with enhanced recovery after surgery.…”

Section: Resultsmentioning

confidence: 99%

“…). Finally a more recent and comprehensive audit of 251 FTS patients over a 3‐year period confirmed that FTS is a feasible and safe programme for women with gynaecological pathologies (Carter & Philp ), with no significant adverse events.…”

Section: Introductionmentioning

confidence: 89%

“…While use of FTS in gynaecological oncology has had a slow start, recent work has evidenced encouraging benefits (Carter et al . 2010a,b; Carter & Philp ; Rooth & Sidhu ). Gynaecological patients' perspective of the programme as delivered by the healthcare team and the hospital is another avenue by which to ascertain whether FTS contributes to patient well‐being, satisfaction and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Patients' satisfaction with fast-track surgery in gynaecological oncology

et al. 2014

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This study investigates the experience and satisfaction with care of fast-tracked gynaecological patients. The Sydney Gynaecological Oncology Group, New South Wales, Australia, has previously shown the benefits of a fast-track surgery programme for gynaecology patients with both complex benign gynaecological pathology and gynaecological malignancy. The question of whether these benefits translate into a positive experience for fast-tracked patients, in the context of their hospital stay and healthcare team care, has not been previously explored in detail. A self-administered satisfaction questionnaire incorporating the European Organisation for Research and Treatment of Cancer (EORTC) cancer in-patient satisfaction with care measure (INPATSAT-32) questionnaire with additional questions was administered to 106 gynaecology participants at Royal Prince Alfred Hospital. Participants reported high levels of satisfaction with patient care and support received from doctors, ward nurses and the hospital as a service and care organisation, within the context of a fast-track surgical programme. Early hospital discharge after gynaecological surgery results in both enhanced recovery after surgery (ERAS) and high levels of patient satisfaction.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Patients' satisfaction with fast-track surgery in gynaecological oncology

et al. 2014

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“…One such strategy is "Fast Track Surgery". The author initiated such a program at a major University Teaching Hospital and commensurate with the principles of clinical governance, has regularly undertaken clinical audit of the program to attest to its ongoing safety and efficacy [6,7,[9][10][11][12][13]. The data presented in this clinical audit represents actual and all surgical performance outcomes, without prejudice, exclusions or exceptions and is the largest reported series of patients with suspected or confirmed gynaecological cancer managed by FTS [14].…”

Section: Discussionmentioning

confidence: 99%

A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Carter¹,

Philp²,

O’Connell³

2014

IJCM

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Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

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“…CPs also improve the coordination of care, ensuring more efficient use of resources and decreasing hospital costs (De Bleser et al., ; Zevola et al., ). For cardiac surgery, a CP has demonstrated a decrease in length of stay in the ICU and hospital as well as duration of intubation (Bjurling‐Sjöberg et al., ; Calligaro, Dougherty, Raviola, Musser, & DeLaurentis, ; Carter & Philp, ; Scott, Seifert, Grimson, & Glass, ; Zevola et al., ). Other studies demonstrating the effectiveness of CP in different patient groups have shown decreases in first oral feeding time (Lyckner, Sjöberg, & Engström, ; Saar et al., ), the first physical activity time (van Mastrigt, Heijmans, & Severens, ; Zevola et al., ), time to first bowel movement (Saar et al., ), antibiotic usage and infectious complications (Usui, Kage, Soda, Noda, & Ishihara, ).…”

Section: Introductionmentioning

confidence: 99%