Early discharge after major gynaecological surgery: advantages of fast track surgery
Jonathan Carter, Shannon Philp, Vivek Arora
DOI: 10.4236/ojog.2011.11001   PDF    HTML     7,456 Downloads   15,431 Views   Citations


Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.

Share and Cite:

Carter, J. , Philp, S. and Arora, V. (2011) Early discharge after major gynaecological surgery: advantages of fast track surgery. Open Journal of Obstetrics and Gynecology, 1, 1-5. doi: 10.4236/ojog.2011.11001.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kehlet, H. and Wilmore, D.W. (2002) Multimodal strategies to improve surgical outcome. American Journal of Surgery, 183, 630-641. doi:10.1016/S0002-9610(02)00866-8
[2] Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIPS), The Royal Australasian College of Surgeons (2009) Brief review: Fast-track surgery and enhanced recovery after surgery (ERAS) programs.
[3] Fearon, K., Ljungqvist, O., Von Meyenfeldt, M., Revhaug, A., Dejong, C., Lassen, K., et al. (2005) Enhanced recovery after surgery: A consensus review of clinical care of patients undergoing colonic resection. Clinical Nutrition, 24, 466-477. doi:10.1016/j.clnu.2005.02.002
[4] Kehlet, H. and Wilmore, D.W. (2008) Evidence-based surgical care and the evolution of fast-track surgery. Annals of Surgery, 248, 189-198. doi:10.1097/SLA.0b013e31817f2c1a
[5] Pruthi, R., Niesen, M., Smith, A., Nix, J., Schultz, H. and Wallen, E. (2010) Fast track program in patients under- going radical cystectomy: Results in 362 consecutive patients. Journal of the American College of Surgeons, 210, 93-99. doi:10.1016/j.jamcollsurg.2009.09.026
[6] Carter, J., Szabo, R., Sim, W., Pather, S., Philp, S., Nattress, K., et al. (2010) Fast track surgery in gynaecological oncology. A clinical audit. Australian and New Zealand Journal of Obstetrics and Gynaecology, 50, 159-163. doi:10.1111/j.1479-828X.2009.01134.x
[7] McDonnell, J.G., O'Donnell, B., Curley, G., Heffernan, A., Power, C. and Laffey, J.G. (2007) The analgesic efficacy of transversus abdominis plane block after abdominal surgery: A prospective randomized controlled trial. Anesthesia & Analgesia, 104, 193-197.
[8] Marx, C., Rasmussen, T., Jakobsen, D.H., Ottosen, C., Lundvall, L., Ottesen, B., et al. (2006) The effect of accelerated rehabilitation on recovery after surgery for ovarian malignancy. Acta Obstetricia et Gynecologica Scandinavica, 85, 488-492. doi:10.1080/00016340500408325
[9] Massad, L., Vogler, G., Herzog, T. and Mutch, D. (1993) Correlates of length of stay in gynecologic oncology patients undergoing inpatient surgery. Gynecologic Oncology, 51, 214-218. doi:10.1006/gyno.1993.1275
[10] Chase, D.M., Lopez, S., Nguyen, C., Pugmire, G.A. and Monk, B.J. (2008) A clinical pathway for postoperative management and early patient discharge: Does it work in gynecologic oncology? American Journal of Obstetrics and Gynecology, 199, e1-e7.
[11] Walker, J.L., Piedmonte, M.R., Spirtos, N.M., Eisenkop, S.M., Schlaerth, J.B., Mannel, R.S., et al. (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic oncology group study LAP2. Journal of Clinical Oncology, 27, 5331-5336.
[12] Kornblith, A.B., Huang, H.Q., Walker, J.L., Spirtos, N.M., Rotmensch, J. and Cella, D. (2009) Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: A gynecologic oncology group study. Journal of Clinical Oncology, 27, 5337-5342.
[13] Mourits, M,, Bijen, C., Art, H., ter Brugge, H., van der Sijde, R., Paulsen, et al. (2010) Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: A randomised trial. Lancet Oncology, 16, 1-9.
[14] de Castro, S., van den Esschert, J., van Heek, N., Dalhuisen, S., Koelemay, M., Busch, O., et al. (2008) A systemic review of the efficacy of gum chewing for the amelioration of postoperative ileus. Digestive Surgery, 25, 39-45. doi:10.1159/000117822
[15] Edward, J., Fitzgerald, F. and Irfan, A. (2009) Systematic Review and Meta-Analysis of Chewing-Gum Therapy in the Reduction of Postoperative Paralytic Ileus Following Gastrointestinal Surgery. World Journal of Surgery, 33, 2557-2566.
[16] Hansen, C., Sorensen, M., Moller, C., Ottesen, B. and Kehlet, H. (2007) Effect of laxatives on gastrointestinal functional recovery in fast-track hysterectomy: A double-blind, placebo-controlled randomized study. American Journal of Obstetrics and Gynecology, 196, 311e1-311e7.
[17] Ljungqvist, O. and Soreide, E. (2003) Preoperative fasting. British Journal of Surgery, 90, 400-406. doi:10.1002/bjs.4066
[18] Macmillan, S., Kammerer-Doak, D., Rogers, R. and Parker, K. (2000) Early feeding and the incidence of gastrointestinal symptoms after major gynecologic surgery. Obstetrics & Gynecology, 96, 604-608. doi:10.1016/S0029-7844(00)00957-1
[19] Schilder, J., Hurteau, J., Look, K., Moore, D., Raff, G., Stehman, F., et al. (1997) A prospective controlled trial of early postoperative oral intake following major abdominal gynecologic surgery. Gynecologic Oncology, 67, 235-240. doi:10.1006/gyno.1997.4860

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.