Fast-track protocol versus conventional protocol on patient outcome: A randomized clinical trial

Abstract

Background: The aim of this study is to compare fast-track methodology with traditional methods of surgical care in achieving better patient outcome, and ensuring a timely discharge from the hospital, and also note the factors that are responsible for a delayed discharge from the hospital. Materials and Methods: One hundred patients undergoing elective surgeries were randomly allocated into fast-track and traditional protocol of perioperative care. Patients who underwent fast-track protocol (FTP) were started on early oral feeding and were encouraged for early discharge, while the others were made to follow the traditional method of recovery. The gastrointestinal functions, postoperative complications and hospital stay time were recorded. The results were tabulated and analyzed. Results: Early feeding was well tolerated by all the patients in the “fast track” group, while the patients in the control group had increased number of “nil by mouth” days, and this result was statistically significant. Ambulation was started earlier in the case group as compared to the controls, and the mean period of starting of ambulation was statistically significant, in the cases as compared to the controls. The patients in the case group had an earlier discharge from the hospital, as compared to the control group. The most common reason for a delay in discharge from the hospital, in either group, was seen to be inadequate pain relief postoperatively. Conclusion: The FTP can significantly shorten the postoperative hospital stay after elective surgery, as compared to the traditional protocol.

Enhanced Recovery After Surgery Guidelines and Hospital Length of Stay, Readmission, Complications, and Mortality

“…Of the 74 included studies, 44 studies (62.2%) reported an overall median or mean estimate of hospital length of stay . The pooled mean length of hospital stay was 1.88 days (95% CI, 0.95-2.81 days; I 2 = 86.5%; P < .001) shorter in the ERAS groups compared with control groups.…”

“…The search strategy yielded 12 047 unique references, of which 1493 were reviewed in full-text, 495 were included in the overall systematic review (eFigure in Supplement 1) and 74 RCTs were included in the meta-analysis. The characteristics of each individual study are included in eTable 1 in Supplement 1.…”

“…The median (range) year of publication was 2019 (2009-2021). Most studies were conducted in high income and high-middle income countries (57 [80.3%]); 22 (29.7%) were published in China, 8 (10.8%) in India, 5 (6.8%) in the US …”

“…Most of the 74 studies examined the outcomes of ERAS in patients undergoing gastrointestinal surgery (32 [43.2%]) and gynecological surgical procedures (11 [14.9%]), with only 1 (1.4%) in cardiac surgery, and 2 (2.7%) in urology . Most of the 74 studies evaluated the outcomes of ERAS guidelines (37 [50.0%]), whereas 23 (31.1%) evaluated enhanced recovery protocols, 13 (17.6%) evaluated fast-track protocols, and 1 (1.4%) evaluated other types of protocols or pathways based on ERAS principles . The mean (SD) number of ERAS elements included in the interventions (ERAS, enhanced protocols, fast-track, other) was 11.1 (3.0) elements of a possible 16.…”

“…The search strategy yielded 12 047 unique references, of which 1493 were reviewed in full-text, 495 were included in the overall systematic review (eFigure in Supplement 1 ) and 74 RCTs 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ...…”