Aim: To confirm the applicability of fast-track program in patients undergoing laparoscopic colorectal surgery and to analyze the economic impact. Methods: Laparoscopic surgery and the implementation of the "fast track" program have radically changed patient management during the last 20 years. In a time of limited financial resources and health expenditure control, the importance of a cost-effectiveness evaluation cannot be ignored when considering new protocols. A comparative, non-blinded prospective evaluation of two cohorts of patients undergoing elective colorectal surgery has been carried out at the General Surgery Department of "Carlo Urbani" Hospital in Jesi, running over 12 months. 118 patients were analyzed and divided in two groups, 67 cases managed with fast track protocol and 51 with traditional treatment. The data were processed with the Chi-Squared test, Student's t test and Mann-Whitney test. Hospitalization costs were classified according to the full costing technique and activity based costing. Results: In the 118 patients enrolled, 55 were males (46.6%) and 63 were females (53.4%); 90 (76%) patients had comorbidities. Interestingly, no differences in overall morbidity and mortality rates were found between the two groups. In particular, patients subjected to fast track treatment did not experience a higher rate of surgical complications while the patients managed with traditional protocol showed a higher number of medical complications. Moreover, the mean length of hospital stay of the fast-track group was 2.37 days shorter than the one of the control group and there was no difference in the 30-day readmission rate. Remarkably, the total cost per patient was significantly lower in the fast track group with respect to the control group (fast-track: 7027 ± 1275 euros vs. control: 7855 ± 1165 euros; p-value < 0.001) and the decrease in hospitalization unit costs was the main factor contributing to the cost reduction. On the contrary, the cost of the operating room and the type of surgical excision did not affect the cost difference between the two groups of patients. Conclusion: The fast track program is applicable and safe in a district hospital. Shorter hospitalization duration is associated with a significant reduction of the hospitalization cost.

Author Name: Angela Maurizi

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Keywords: Colorectal surgery; Fast-track; Cost analysis; Enhanced recovery; District hospital

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EISSN: 2474-1647

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