Fast-track in Minimally Invasive Gynaecology

Fast-track in Minimally Invasive Gynaecology: a Randomized Trial Comparing Costs and Clinical Outcomes

Objective: Evaluate the effects of a fast-track (FT) protocol on costs and postoperative recovery.

Design: randomized trial

Setting: University Hospitals

Population: 170 women undergoing total laparoscopic hysterectomy for a benign indication

Methods: A FT protocol included the combination of minimally invasive surgery, analgesia optimization, early oral refeeding and rapid mobilization of patients was compared to a usual care protocol.

Main outcomes measure: Primary outcome was costs. Secondary outcomes were length of stay, postoperative morbidity and patient satisfaction.

1. Fast-Track protocol:

   Preoperative

   • Anesthetic consultation
   • Proposal of optimization of patient's general health state + family meeting if necessary
   • Hospitalization on day of surgery
   • Solids stopped 6 hours prior to surgery, drinking encouraged up to 2 hours prior to surgery

   During surgery

   • Anti-infectious prophylaxis
   • Anesthesia via IV propofol/remifentanil
   • Anti-nausea prophylaxis
   • Pain control based on limited systemic opioid use

   Postoperative

   • Balanced analgesia for pain control
   • Antithrombotic prophylaxis
   • Early oral refeeding
   • Rapid mobilization
   • Gum chewing
   • Foley catheter removal at the end of surgery
   • Peripheral IV catheter removal 6 hours postoperatively

2. Usual care protocol :

Preoperative

• Anesthetic consultation
• Hospitalization on day of surgery
• Fasting beginning at midnight prior to surgery

During surgery

• Anti-infectious prophylaxis
• Balanced anesthesia via halogen gas
• Anti-nausea medication if needed

Postoperative

• Balanced analgesia for pain control
• Antithrombotic prophylaxis
• Same-day refeeding according to patient's wish
• Same-day mobilization according to patient's wish
• Foley and peripheral IV catheter removal on day 1 postoperatively

Inclusion Criteria:

• women undergoing total laparoscopic hysterectomy for a benign indication

Exclusion Criteria:

• the requirement for an additional surgical procedure, such as prolapse repair or urinary incontinence, because a prolonged operative time could compromise early patient discharge and
• the inability to speak French because the patients were required to complete their data collection logbook in French.