Articles de revues : « Fast track protocol »

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Kakihana, Yasuyuki. « Fast-track extubation protocol after cardiac surgery ». Journal of the Japanese Society of Intensive Care Medicine 14, n^o 4 (2007) : 625–26. http://dx.doi.org/10.3918/jsicm.14.625.

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Navalon Verdejo, Pedro, Victor Navalon-Monllor, Alba Monzo-Cataluna, Celia Ramada-Calaforra, Felipe Ordono-Dominguez et Yoni Pallas-Costa. « 'Fast-Track' Protocol for Penile Curvature Treatment ». Journal of Anesthesia and Surgery 4, n^o 2 (22 juillet 2017) : 71–76. http://dx.doi.org/10.15436/2377-1364.17.076.

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Kovalenko, Zahar, Vladimir Lyadov, Konstantin Lyadov, Ivan Kozyrin, Alla Kamalova et Natalia Saltynskaya. « Implication of fast track protocol in pancreatoduodenectomy ». Pancreatology 16, n^o 3 (juin 2016) : S90—S91. http://dx.doi.org/10.1016/j.pan.2016.05.305.

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Feo, Carlo V., Serena Lanzara, Davide Sortini, Riccardo Ragazzi, Mario De Pinto, Gian Carlo Pansini et Alberto Liboni. « Fast Track Postoperative Management after Elective Colorectal Surgery : A Controlled Trail ». American Surgeon 75, n^o 12 (décembre 2009) : 1247–51. http://dx.doi.org/10.1177/000313480907501219.

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In the attempt to reduce postoperative complications and costs and improve outcomes, the concept of fast track surgery has been proposed. Improvements in anesthesia techniques and a better understanding of the pathophysiologic events occurring during and after surgery have made it possible. A group of patients undergoing colorectal resections with a fast track approach were investigated; specifically, the effects on postoperative morbidity, resumption of intestinal function, and duration of hospitalization. Fifty patients were managed according to a protocol, which included epidural analgesia, early ambulation, and oral feeding (fast track group); they were compared with 50 patients managed with a different protocol: no epidural analgesia, early ambulation, and early oral diet (control group). Primary outcome end-points reported include morbidity, time to passage of flatus and stool, and length of hospital stay. Fourteen complications occurred in the fast track group and 13 in the control group ( P = not significant (NS)). Resumption of intestinal function occurred after 3 days, and length of hospital stay was 5 days in the fast track group compared with 4 and 7 days respectively in control patients ( P = NS, P < 0.01). Patients undergoing elective colorectal resections can be managed safely with fast track protocols reducing hospital stay.

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Barbieri, Francesca, Giorgio Poletto, Enrico Giustiniano et Efrem Civilini. « A Fast-Track Protocol for Carotid Artery Surgery ». EJVES Vascular Forum 54 (2022) : e22-e23. http://dx.doi.org/10.1016/j.ejvsvf.2021.12.030.

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Zouros, Efstratios, Theodoros Liakakos, Anastasios Machairas, Paulos Patapis, Helen Tzerbinis, Dimitrios K. Manatakis, Matthaios Papadimitriou-Olivgeris et Christos Dervenis. « Fast-Track Pancreaticoduodenectomy in the Elderly ». American Surgeon 83, n^o 3 (mars 2017) : 239–49. http://dx.doi.org/10.1177/000313481708300318.

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It remains uncertain whether enhanced recovery after surgery (ERAS) protocols can be safely implemented for elderly patients, especially after highly complex surgery such as pancreaticoduodenectomy (PD). The present study was designed to assess the feasibility and safety of an ERAS protocol in elderly patients undergoing PD. Starting January 2010 to February 2015, we prospectively collected data from 85 consecutive patients who underwent PD with a fast-track program. Data of patients older and younger than 70 years were compared. Endpoints were morbidity, mortality, readmissions, length of stay, and compliance with ERAS elements. Forty-five patients were less than 70 years old and 40 patients were 70 years of age or older. Both mortality (4.4% vs 5%; P = 1.000) and overall morbidity (33.3% vs 37.5%; P = 0.821) did not differ significantly between the groups. Rates of intervention and relaparotomy were similar in both groups. Length of stay (10 vs 11.8 days; P = 0.099) did not differ significantly between the groups, nor did the readmission rates (6.7% vs 5.0%; P = 0.272). There were no differences in compliance with ERAS elements between groups. An ERAS program seems feasible and can be safely implemented for elderly patients undergoing PD.

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Wehberg, Kurt E., Debra Jackson, Joseph Walters, Brandon Redmond, James C. Todd, Nicholas L. Ogburn et Steven Leonard. « Fast Track Minimally Invasive Transmyocardial Revascularization ». Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery 4, n^o 4 (juillet 2009) : 217–20. http://dx.doi.org/10.1097/imi.0b013e3181a69c51.

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Objective We evaluated the initial results of a fast-track discharge protocol for patients undergoing minimally invasive transmyocardial revascularization (MiTMR). Methods Fifteen male patients, aged 64.5 ± 9.2 years, with an ejection fraction of 46.8% ± 9.9%, underwent MiTMR through a mini-left anterior thoracotomy aided by robotic-controlled thoracoscopic assistance. A postoperative management protocol included immediate extubation, early chest tube and pulmonary artery catheter removal, and mobilization within 12 hours. Results There were no operative arrhythmias or in-hospital mortalities. Three of 15 patients developed left lower lobe atelectasis, delaying discharge between 2 and 5 days. Overall hospital length of stay was 1.4 ± 1.2 days, although 12 of 15 patients (80%) were discharged to home in 23 hours. Mild-moderate cardiomyopathy (ejection fraction 30%–50%) was not associated with prolonged length of stay. Mean hospital profit margin was $1882.50. One 30-day readmission occurred on day 23 for rapid atrial fibrillation, and one death occurred on day 11. Conclusions Despite these high-risk patients having end-staged, ischemic coronary artery disease, most MiTMR patients can be discharged to home in less than 24 hours. Perioperative morbidity and mortality rates are relatively low, and hospital profit margins are modest.

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Ollivere, B., K. Rollins, R. Brankin, M. Wood, TJ Brammar et J. Wimhurst. « Optimising fast track care for proximal femoral fracture patients using modified early warning score ». Annals of The Royal College of Surgeons of England 94, n^o 4 (mai 2012) : 267–71. http://dx.doi.org/10.1308/003588412x13171221501744.

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INTRODUCTION The care for patients with a proximal femoral fracture has been dramatically overhauled with the introduction of ‘fast track’ protocols and the British Orthopaedic Association guidance in 2007. Fast track pathways focus on streamlining patient flow through the emergency department where the guidance addresses standards of care. We prospectively examined the impact these protocols have on patient care and propose an alternative ‘streamed care’ pathway to provide improved medical care within existing resource constraints. METHODS Data surrounding the treatment of 156 consecutive patients managed at 4 centres were collated prospectively. Management of patients with a traditional fast track protocol allowed 17% of patients to leave the emergency department with undiagnosed serious medical pathology and 32% with suboptimal fluid resuscitation. A streamed care pathway based on the modified early warning score was developed and employed for 48 further patients as an alternative to the traditional fast track system. RESULTS The streamed care pathway improved initial care significantly by treating patients according to their physiological parameters on admission. Targeted medical reviews on admission instead of the following day reduced the rates of undiagnosed medical pathology to 2% (p=0.0068) and inadequate fluid resuscitation to 11% (p<0.0001). CONCLUSIONS Implementation of a streamed care pathway can allow protocol driven improvement to initial care for patients with a proximal femoral fracture and results in improved access to initial specialist medical care.

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Verdejo, Pedro Navalon. « DEVELOPMENT OF A “FAST-TRACK” PROTOCOL FOR HYDROCELE SURGERY ». Journal of Anesthesia and Surgery 3, n^o 6 (2016) : 1–5. http://dx.doi.org/10.15436/2377-1364.16.055.

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Gromov, Kirill, Pelle B. Petersen, Christoffer C. Jørgensen, Anders Troelsen et Henrik Kehlet. « Unicompartmental knee arthroplasty undertaken using a fast-track protocol ». Bone & ; Joint Journal 102-B, n^o 9 (1 septembre 2020) : 1167–75. http://dx.doi.org/10.1302/0301-620x.102b9.bjj-2020-0247.r1.

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Aims The aim of this prospective multicentre study was to describe trends in length of stay and early complications and readmissions following unicompartmental knee arthroplasty (UKA) performed at eight different centres in Denmark using a fast-track protocol and to compare the length of stay between centres with high and low utilization of UKA. Methods We included data from eight dedicated fast-track centres, all reporting UKAs to the same database, between 2010 and 2018. Complete ( > 99%) data on length of stay, 90-day readmission, and mortality were obtained during the study period. Specific reasons for a length of stay of > two days, length of stay > four days, and 30- and 90-day readmission were recorded. The use of UKA in the different centres was dichotomized into ≥ 20% versus < 20% of arthroplasties which were undertaken being UKAs, and ≥ 52 UKAs versus < 52 UKAs being undertaken annually. Results A total of 3,927 procedures were included. Length of stay (mean 1.1 days (SD 1.1), median 1 (IQR 0 to 1)) was unchanged during the study period. The proportion of procedures with a length of stay > two days was also largely unchanged during this time. The percentage of patients discharged on the day of surgery varied greatly between centres (0% to 50% (0 to 481)), with centres with high UKA utilization (both usage and volume) having a larger proportion of same-day discharges. The 30- and 90-day readmissions were 166 (4.2%) and 272 (6.9%), respectively; the 90-day mortality was 0.08% (n = 3). Conclusion Our findings suggest general underutilization of the potential for quicker recovery following UKA in a fast-track setup. Cite this article: Bone Joint J 2020;102-B(9):1167–1175.

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Feroci, Francesco, Elisa Lenzi, Maddalena Baraghini, Alessia Garzi, Andrea Vannucchi, Stefano Cantafio et Marco Scatizzi. « Fast-track colorectal surgery : protocol adherence influences postoperative outcomes ». International Journal of Colorectal Disease 28, n^o 1 (2 septembre 2012) : 103–9. http://dx.doi.org/10.1007/s00384-012-1569-5.

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Darvin, V. V., A. Y. Ilkanich et Yu S. Voronin. « IMPLEMENTATION OF FAST-TRACK PROGRAM FOR STOMA REVERSAL PROCEDURES ». Koloproktologia 19, n^o 1 (16 mars 2020) : 67–72. http://dx.doi.org/10.33878/2073-7556-2020-19-1-67-72.

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AIM: evaluation of the effectiveness of the enhanced recovery protocol for stoma reversal procedures.PATIENTS AND METHODS: a single-center retrospective analysis of stoma reversal surgery in 130 ostomy patients in 2012-18 was performed. From 2012 to 2015, 56 (43.1%) patients were treated before the implementation of the Enhanced Recovery After Surgery (ERAS) protocol in clinical practice, 74(56.9%) patients were treated in accordance with the principles of fast-track.RESULTS: the introduction into clinical practice of the ERAS protocol reduced postoperative complications from 8.5% to 5.4% (p=0.002) and the hospital stay from 16,3±9,4 to 11,4±4,2 days (p=0.003).CONCLUSION: the fast-track strategy is an effective way to improve the results of stoma reversal procedures.

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Gomes, Clint, Nigel Jones et Neil Heron. « Sports-related concussion (SRC) in track cycling : SRC assessment protocol for elite track cycling ». BMJ Open Sport & ; Exercise Medicine 8, n^o 3 (août 2022) : e001384. http://dx.doi.org/10.1136/bmjsem-2022-001384.

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Track cycling is a fast, exciting sport and requires a specific sports-related concussion (SRC) assessment protocol. This paper proposes the first SRC assessment protocol for use in track cycling and proposes that this should occur in three stages. Stage 1 will occur at the trackside, whilst stage 2 occurs in the changing room immediately after the event and stage 3 the day following the suspected SRC. This SRC protocol is in its first iteration and we hope it stimulates debate to allow further refinement.

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Kareem, Zeeshan, et SandhyaP Iyer. « Fast-track protocol versus conventional protocol on patient outcome : A randomized clinical trial ». Nigerian Journal of Surgery 25, n^o 1 (2019) : 36. http://dx.doi.org/10.4103/njs.njs_34_17.

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Kapritsou, Maria, Evangelos A. Konstantinou, Dimitris P. Korkolis, Maria Kalafati, Ioannis Kaklamanos et Margarita Giannakopoulou. « Postoperative stress and pain response applying fast-track protocol in patients undergoing hepatectomy ». Journal of Perioperative Practice 29, n^o 11 (12 novembre 2018) : 368–77. http://dx.doi.org/10.1177/1750458918812293.

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Aim To assess the clinical parameters and compare the stress and pain response between fast-track recovery protocol and conventional treatment in patients undergoing major liver resection. Methods Eighty-eight patients suffering from malignant liver tumours were surgically treated from May 2012 to March 2015. After randomisation, they were prospectively divided into two groups: group fast-track patients (n = 46) and group conventional treatment patients (n = 42). Demographic and clinical data were collected and patients were assessed with pain scale (behavioural observation scale and visual analog scale), while depression levels were evaluated with Zung self-rating depression scale and three Numeric Analog Scale self-reported questions. Peripheral blood samples were collected at time points: T1 on the admission day, T2 on the day of surgery and T3 on the day of discharge examining serum levels of adrenocorticotropic hormone and cortisol. Conclusion Fast-track recovery protocols seem to be associated with improvement in several clinical parameters, without compromising, biologic or emotional stress in patients undergoing major liver resection.

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Hui, Vanessa, Neil Hyman, Christopher Viscomi et Turner Osler. « Implementing a fast-track protocol for patients undergoing bowel resection : not so fast ». American Journal of Surgery 206, n^o 2 (août 2013) : 152–58. http://dx.doi.org/10.1016/j.amjsurg.2012.11.019.

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Zitta, D. V., et V. M. Subbotin. « INFLUENCE OF DEFUNCTIONING COLOSTOMY AFTER LOW ANTERIOR RESECTION FOR RECTAL CANCER ON EARLY POSTOPERATIVE PERIOD ». Koloproktologia, n^o 3 (30 septembre 2017) : 34–39. http://dx.doi.org/10.33878/2073-7556-2017-0-3-34-39.

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The AIM of this study was to evaluate the influence of defunctioning colostomy after low anterior resection for cancer on early postoperative period and effectiveness of Fast Track protocol. MATERIALS. Retrospective analysis of medical records of 186 patients with rectal cancer who underwent anterior resection of the rectum in our department was done. All patients were allocated into 2 groups - conventional (had conventional perioperative care) and optimized (perioperative treatment according to Fast Track protocol). Both groups were subdivided into 3 subgroups (unprotected anastomosis, defunctioning colostomy and Hartmann procedure). The following data were analysed: average time of operation, operative bloodloss, volume of infusion and urination, time of mobilization removement of dranages and catheters, postoperative complications. RESULTS. Age, sex, comorbidities had no effect on decision about a preventive colostomy. The main reason for preventive colostomy was a middle-rectum location of a tumor. Preventive colostomy didn’t affect the course of early postoperative period in groups. Defunctioning colostomy effectively prevent catastrophic consequences of anastomotic leakage and didn’t compromise Fast Track protocol. CONCLUSION. Defunctioning colostomy did not reduce postoperative anastomotic leak rate, but mitigate consequences of an anastomotic leakage. Defunctioning colostomy did not affect the course of early postoperative period and Fast Track protocol.

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Zakhary, Waseem, Jacob Lindner, Sophia Sgouropoulou, Sarah Eibel, Stefan Probst, Markus Scholz et Joerg Ender. « Independent Risk Factors for Fast-Track Failure Using a Predefined Fast-Track Protocol in Preselected Cardiac Surgery Patients ». Journal of Cardiothoracic and Vascular Anesthesia 29, n^o 6 (décembre 2015) : 1461–65. http://dx.doi.org/10.1053/j.jvca.2015.05.193.

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Zitta, D., V. Subbotin et Y. Busirev. « THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER ». Koloproktologia, n^o 1 (30 mars 2016) : 26–29. http://dx.doi.org/10.33878/2073-7556-2016-0-1-26-29.

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Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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Raftopoulos, Ioannis. « Fast-Track Protocol for Laparoscopic Roux-en-Y Gastric Bypass ». Journal of the American College of Surgeons 223, n^o 1 (juillet 2016) : 203–4. http://dx.doi.org/10.1016/j.jamcollsurg.2016.04.016.

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Sorel, M. R., M. A. van Leeuwen, J. L. Schols et H. H. E. van Melick. « Ervaringen met een fast-track protocol bij urinedeviatie volgens Bricker ». Tijdschrift voor Urologie 2, n^o 1 (février 2012) : 6–10. http://dx.doi.org/10.1007/s13629-012-0003-7.

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Montal, S., E. A. Silberman, P. I. Olano, S. Marchionatti, A. Gonzalez Campaña, M. J. Barreiro, M. Fauda, L. G. Podesta et O. C. Andriani. « Application of a fast-track protocol in open liver surgery ». HPB 18 (avril 2016) : e104. http://dx.doi.org/10.1016/j.hpb.2016.02.245.

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Grützner, Henrike, Anna Flo Forner, Massimiliano Meineri, Aniruddha Janai, Jörg Ender et Waseem Zakaria Aziz Zakhary. « A Comparison of Patients Undergoing On- vs. Off-Pump Coronary Artery Bypass Surgery Managed with a Fast-Track Protocol ». Journal of Clinical Medicine 10, n^o 19 (28 septembre 2021) : 4470. http://dx.doi.org/10.3390/jcm10194470.

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The purpose of this study was to compare patients who underwent on- vs. off-pump coronary artery bypass surgery managed with a fast-track protocol. Between September 2012 and December 2018, n = 3505 coronary artery bypass surgeries were managed with a fast-track protocol in our specialized post-anesthesia care unit. Propensity score matching was applied and resulted in two equal groups of n = 926. There was no significant difference in ventilation time (on-pump 75 (55–120) min vs. off-pump 80 (55–120) min, p = 0.973). We found no statistically significant difference in primary fast-track failure in on-pump (8.2% (76)) vs. off-pump (6% (56)) groups (p = 0.702). The secondary fast-track failure rate was comparable (on-pump 12.9% (110) vs. off-pump 12.3% (107), p = 0.702). There were no significant differences between groups in regard to the post-anesthesia care unit, the intermediate care unit, and the hospital length of stay. Postoperative outcome and complications were also comparable, except for a statistically significant difference in PACU postoperative blood loss in on-pump (234 mL) vs. off-pump (323 mL, p < 0.0001) and red blood cell transfusion (11%) and (5%, p < 0.001), respectively. Our results suggest that on- and off-pump coronary artery bypass surgery in fast-track settings are comparable in terms of ventilation time, fast-track failure rate, and postoperative complications rate.

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Fei, Yang, Guang-quan Zong, Jian Chen et Ren-min Liu. « Fast-track protocols in devascularization for cirrhotic portal hypertension ». Revista da Associação Médica Brasileira 61, n^o 3 (juin 2015) : 250–57. http://dx.doi.org/10.1590/1806-9282.61.03.250.

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Summary Introduction/objective: fast-tract surgery (FTS) has been rapidly embraced by surgeons as a mechanism for improving patient care and driving down complications and costs. The aim of this study was to determine if any improvement in outcomes occurred after FTS protocol for selective double portazygous disconnection with preserving vagus (SDPDPV) compared with non-FTS postoperative care. Methods: patients eligible for SDPDPV in the period January 2012-April 2014 were randomly selected for the FTS group or non-FTS group. A designed protocol was used in the FTS group with emphasis on an interdisciplinary approach. The non-FTS group was treated using previously established standard procedures. The number of postoperative complications, time of functional recovery and duration of hospital stay were recorded. Results: patients in the FTS group (n=59) and non-FTS group (n=57) did not differ in terms of preoperative data and operative details (p>0.05). The FTS procedure led to significantly better control and faster restoration of gastrointestinal functions, food tolerance, rehabilitation and hospital discharge (p<0.05). Postoperative complications, including nausea/vomiting, severe ascites, wound infection, urinary tract infection and pulmonary infection were all significantly lower in the FTS group (p<0.05). According to the postoperative morbidity classification used by Clavien, overall complications and grade I complications were both significantly lower in the FTS group compared with the non-FTS group (p<0.05). Conclusion: adopting the FTS protocol helped to recover gastrointestinal functions, to reduce frequency of postoperative complications and to reduce hospital stay. The FTS strategy is safe and effective in improving postoperative outcomes.

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Silva, José Pedro Carvalho Moreira da. « Fast-track surgery in colorectal surgery : When laparoscopy is not an option. » Journal of Clinical Oncology 30, n^o 4_suppl (1 février 2012) : 642. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.642.

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642 Background: “Fast-track” protocols are multimodal programs that when applied to colorectal surgery, permit a reduction in morbidity, hospital stay and a faster recovery after the surgery. Most of these protocols are associated to laparoscopic surgery. However it is possible to reproduce these results with open surgery, when laparoscopy is not an option (lack of material or medical experience or in low-resource scenario). Methods: Main objective: 1) Apply a fast-track protocol, designed to our patients that have colon malignancies and are submitted to colon resections through an open procedure 2) To study the peri-operative morbidity in the first 30 days after surgery. We conducted a pilot study with 30 patients in 2007. After assuring the feasibility of this protocol we started to apply it regularly in 2009; 177 patients underwent to fast track open colorectal surgery until July 2011. Main studied outcomes were duration of the surgical procedure, pain control, postoperative complications, and length of hospital stay. Other variables included patient (demographic characteristics, BMI, ASA and POSSUM scores), tumour (TNM status) and surgery (type) related variables. Results: 54,8% of the patients were male. Median age was 63 years old (Min.: 36; Máx.: 79). 53,7% had sigmoid or rectosigmoid tumors. Most were classified as pT3N0 tumors. In 89% of the patients, epidural catheter was placed. 92,7% had a vertical median abdominal incision with a median of 19 cm (Min.: 10; Máx.: 30). The most performed surgery was the sigmoid colectomy and the anterior rectosigmoid resection. 89,3% tolerated oral clear liquids, 2 hours after surgery. 31,6% of the patients referred nauseas or vomits in the post-operative period. 83,6% didn't refer pain after the surgery. 2,83% had an anastomotic fistula and had to be reoperated (similarly to historical data). 36,7% were discharged at day three after surgery and 87% have been discharged by the 5th day. Conclusions: The “Fast-track” protocol applied to open colon surgery is feasible, doesn’t increase the morbidity or mortality and permits shorter hospital stays and is not expensive. To its success contribute the detailed information to the patient, the formation and the motivation of the health care people involved.

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Krajcer, Zvonimir, Venkatesh G. Ramaiah, Esteban A. Henao, D. Chris Metzger, Wayne K. Nelson, Mohammed M. Moursi, Hiranya A. Rajasinghe, Raed Al-Dallow et Larry E. Miller. « Perioperative Outcomes From the Prospective Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry ». Journal of Endovascular Therapy 25, n^o 1 (18 décembre 2017) : 6–13. http://dx.doi.org/10.1177/1526602817747871.

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Purpose: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients. Methods: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge. The primary endpoint was major adverse events (MAE) through 30 days. The target performance goal for the MAE endpoint was 10.4%. Results: Vascular access, stent-graft delivery, and stent-graft deployment success were 100%. A total of 216 (86%) patients completed all elements of the fast-track EVAR protocol. Completion of individual elements was 98% for general anesthesia avoidance, 97% for bilateral percutaneous access, 96% for ICU avoidance, and 92% for next-day discharge. Perioperative outcomes included mean procedure time of 88 minutes, median blood loss of 50 mL, early oral nutrition (median 6 hours), early mobilization (median 8 hours), and short hospitalization (median 26 hours). Fast-track EVAR completers had shorter procedure time (p<0.001), less blood loss (p=0.04), faster return to oral nutrition (p<0.001) and ambulation (p<0.01), and shorter hospital stay (p<0.001). With 241 (96%) of the 250 patients returning for the 30-day follow-up, the MAE incidence was 0.4% (90% CI 0.1% to 1.8%), significantly less than the 10.4% performance goal (p<0.001). No aneurysm rupture, conversion to surgery, or aneurysm-related secondary procedure was reported. There were no type III endoleaks and 1 (0.4%) type I endoleak. Iliac limb occlusion was identified in 2 (0.8%) patients. The 30-day hospital readmission rate was 1.6% overall. Conclusion: A fast-track EVAR protocol was feasible in well-selected patients and resulted in efficient perioperative resource utilization with excellent safety and effectiveness.

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Biancofiore, Gianni, Dana Rodica Tomescu et M. Susan Mandell. « Rapid Recovery of Liver Transplantation Recipients by Implementation of Fast-Track Care Steps : What Is Holding Us Back ? » Seminars in Cardiothoracic and Vascular Anesthesia 22, n^o 2 (28 février 2018) : 191–96. http://dx.doi.org/10.1177/1089253218761124.

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A body of scientific studies has shown that early extubation is safe and cost-effective in a large number of liver transplant (LT) recipients including pediatric patients. However, fast-track practices are not universally accepted, and debate still lingers about whether these interventions are safe and serve the patients’ best interest. In this article, we focus on reasons why physicians still have a persistent, although diminishing, reluctance to adopt fast-track protocols. We stress the importance of collection/analysis of perioperative data, adoption of a consensus-based standardized protocol for perioperative care, and formation of LT anesthesia focused teams and leadership. We conclude that the practice of early extubation and fast-tracking after LT surgery could help improve anesthesia performance, safety, and cost-effectiveness.

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Andrzejewski, Krzysztof, Marcin Elgalal, Piotr Komorowski, Jan Poszepczyński, Bożena Rokita et Marcin Domżalski. « Fast-Track-Protocol for Optimization of Presurgical Planning in Acute Surgical Treatment of Acetabular Quadrilateral Plate Fractures Using 3D Printing Technology and Pre-Contoured Reconstruction Plates ». Applied Sciences 12, n^o 7 (30 mars 2022) : 3492. http://dx.doi.org/10.3390/app12073492.

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Background. Preoperative planning and 3D printing can be used to treat pelvic bone fractures using pre-contoured surgical plates, in particular complex, comminuted fractures involving the acetabulum and quadrilateral plate. The aim of the study was to develop a Fast-Track-Protocol (fast track methodology) for creating 3D anatomical models, that could be used to shape surgical plates, using open-source software and budget 3D printers. Such a ‘low-budget’ approach would allow a hospital-based multidisciplinary team to carry out pre-surgical planning and treat complex pelvic fractures using 3D technology. Methods. The study included 5 patients with comminuted pelvic fractures. For each patient, CT (computed tomography) data were converted into two 3D models of the pelvis-injured side and mirrored model of the contralateral, uninjured hemipelvis. These models were 3D printed and used as templates to shape surgical plates. Results. A Fast-Track-Protocol was established and used to successfully treat 5 patients with complex, comminuted fractures of the pelvis. Conclusion. Using the Fast-Track-Protocol it was possible to prepare 3D printed models and patient-specific pre-contoured plates within 2 days of hospital admittance. Such an approach resulted in better surgical technique and shorter operative times, while incurring relatively low costs.

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Mangukia, Chirantan, Mehul Kachhadia et Manish Meswani. « Fast-track off-pump coronary artery bypass : single-center experience ». Asian Cardiovascular and Thoracic Annals 27, n^o 4 (24 février 2019) : 256–64. http://dx.doi.org/10.1177/0218492319833266.

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Aim The primary goal of the study was to perform retrospective analysis of fast-track coronary artery bypass grafting at our institute to identify risk factors for prolonged hospital stay. A secondary goal was to identify and compare survival statistics with those published in literature. Method We performed a retrospective analysis of patients enrolled in our fast-track coronary artery bypass protocol. There were 709 patients with a mean age of 58.85 ± 8.9 years; 572 were men. The mean EuroSCORE II was 2.02% ± 2.64%. Of these 709 patients, 538 (76%) met the requirements for discharge within 100 hours. Results Prolonged ventilation or reintubation, major pulmonary complications, gastrointestinal and neurological complications were the strongest predictors of fast-track failure. Persistent atrial fibrillation, postoperative transient renal impairment, requirement for noninvasive ventilation > 3 times, sternal wound infection, insulin-dependent diabetes mellitus, preoperative intraaortic balloon pump for chest pain or ST changes, preoperative severe left ventricular dysfunction, preoperative severe renal impairment, and peripheral arterial disease were also found to be significant risk factors for fast-track failure. Cumulative survival at 66 months of follow-up was 90.2% ± 0.02%. Conclusion The risk factors listed above were associated with fast-track failure. Smoking cessation helps to nullify the factor of chronic obstructive pulmonary disease. Intraoperative elective insertion of a balloon pump does not affect the fast-track protocol. Survival was comparable to that described in the literature.

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Ehrlich, A., B. Wagner, M. Kairaluoma, J. P. Mecklin, H. Kautiainen et I. Kellokumpu. « Evaluation of a fast-track protocol for patients undergoing colorectal surgery ». Scandinavian Journal of Surgery 103, n^o 3 (2 avril 2014) : 182–88. http://dx.doi.org/10.1177/1457496913516295.

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Corcoy, Marta, Gloria Nohales, Ester Ruz, Javier Oliva, Ana Pardo et Lluis Cecchini. « Difficulties in implantation of a fast-track protocol for radical cystectomy ». Clinical Nutrition ESPEN 12 (avril 2016) : e40-e41. http://dx.doi.org/10.1016/j.clnesp.2016.02.035.

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Iezzi, Federica, Michele di Summa, Paolo Del Sarto et James Munene. « Fast-Track Extubation in Pediatric Cardiothoracic Surgery in Developing Countries ». Journal of Cardiac Critical Care TSS 01, n^o 01 (août 2017) : 021–23. http://dx.doi.org/10.1055/s-0037-1604334.

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Objective In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. Methods There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, and no active bleeding. In this setting, a careful choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. Results The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing postoperative complications in pediatric congenital heart disease. Conclusion This study supports a wider use of fast-track extubation protocols in pediatric patients submitted for congenital cardiac surgery in developing countries.

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Toraman, Fevzi, Serdar Evrenkaya, Murat Yuce, Onur G�ksel, Hasan Karabulut et Cem Alhan. « Fast-Track Recovery in Noncoronary Cardiac Surgery Patients ». Heart Surgery Forum 8, n^o 1 (16 février 2005) : 61. http://dx.doi.org/10.1532/hsf98.20041138.

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Objective: Fast-track recovery protocols result in shorter hospital stays and decreased costs in coronary artery bypass grafting (CABG) surgery. However, data based on an objective scoring system are lacking for the impact of these protocols on patients undergoing cardiac surgery other than isolated CABG. Methods: Between March 1999 and March 2003, 299 consecutive patients who underwent open cardiac surgery other than isolated CABG were analyzed to evaluate the safety and efficacy of fast-track recovery. The parameters evaluated as predictors of mortality, ie, delayed extubation (>360 minutes), intensive care unit (ICU) discharge (>24 hours), increased length of hospital stay (>5 days), and red blood cell transfusion, were determined by regression analysis. Standard perioperative data were collected prospectively for every patient. Results: Seventy-two percent of the patients were extubated within 6 hours, 87% were discharged from the ICU within 24 hours, and 60% were discharged from the hospital within 5 days. No red blood cells were transfused in 67% of the patients. There were no predictors of mortality. The predictors of delayed extubation were preoperative congestive heart failure (P = .005; odds ratio [OR], 4.5; 95% confidence interval [CI], 1.6-12.6) and peripheral vascular disease (P = .02; OR, 6; 95% CI, 1.9-19.4). Factors leading to increased ICU stay were diabetes (P = .05; OR, 3.6; 95% CI, 1-12.6), emergent operation (P = .04; OR, 6.1; 95% CI, 1.1-33.2), red blood cell transfusion (P = .03; OR, 2.9; 95% CI, 1.1-7.8), chest tube drainage >1000 mL (P = .03; OR, 3.4; 95% CI, 1.1-10.2). The predictors of increased length of hospital stay were ICU stay >24 hours (P = .001; OR, 5.9; 95% CI, 2-17), EuroSCORE >5 (P = .05; OR, 1.8; 95% CI, 1-3.2), and chronic obstructive pulmonary disease (P = .003; OR, 3.7; 95% CI, 1.5-8.7). Predictive factors for transfusion of red blood cells were diabetes (P = .04; OR, 2.9; 95% CI, 1.1-8.1), delayed extubation (P = .02; OR, 2.7; 95% CI, 1.4-5.1), increased ICU stay (P = .04; OR, 2.6; 95% CI, 1-6.4), and chest tube drainage >1000 mL (P = .001; OR, 4.3; 95% CI, 2-9.3). Conclusions: This study confirms the safety and efficacy of the fast-track recovery protocol in patients undergoing open cardiac surgery other than isolated CABG.

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Malinovsky, A. V., et M. M. Galimon. « THE FIRST RESULTS OF A MINI-LAPAROSCOPIC CHOLECYSTECTOMY USING THE FAST-TRACK PROTOCOL ». Kharkiv Surgical School, n^o 3-4 (20 décembre 2019) : 77–79. http://dx.doi.org/10.37699/2308-7005.3-4.2019.15.

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Summary. The aim of the study is to analyze the first results of mini-laparoscopic cholecystectomy in acute and chronic calculouscholecystitis using the fast-track protocol. The study included women aged 20 to 50 years with a body mass index of 18 to 35 kg/m2, whom the cosmetic effect of the operation was important, and quick rehabilitation times. The average age of the patients was 38 years (from 33 to 48 years). The average body mass index was 24.2 kg/m2 (from 19.0 to 30.1 kg/m2). The patient was divided into 2 groups. The main group consisted of 9 women who underwent mini-laparoscopic cholecystectomy, including 2 cases of acute calculouscholecystitis, with using the fast-track protocol. The control group consisted of 7 women who underwent the traditional laparoscopic cholecystectomy using a standard protocol for post-operative management.

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Lindberg-Larsen, Martin, Pelle Baggesgaard Petersen, Yasemin Corap, Kirill Gromov, Christoffer Calov Jørgensen et Henrik Kehlet. « Fast-track revision hip arthroplasty : a multicenter cohort study on 1,345 elective aseptic major component revision hip arthroplasties ». Acta Orthopaedica 93 (23 février 2022) : 341–47. http://dx.doi.org/10.2340/17453674.2022.2196.

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Background and purpose: Data on application of fasttrack/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures. Patients and methods: This is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included. Results: 1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2–6), decreasing from median 6 (IQR 3–10) days in 2010 to 2 (IQR 1–4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70–79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days). Interpretation: LOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.

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Gumenyuk, L. N., Z. Z. Khayretdinova et G. A. Puchkina. « BIOCHEMICAL AND PSYCHOSOCIAL ASPECTS OF FAST TRACK SURGERY IN SURGICAL PATIENTS WITH COMORBID METABOLIC SYNDROME IN GYNECOLOGICAL PRACTICE ». Ulyanovsk Medico-biological Journal, n^o 3 (28 septembre 2020) : 70–81. http://dx.doi.org/10.34014/2227-1848-2020-3-70-81.

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The aim of the paper was to study the influence of the Fast Track surgery on the perioperative dynamics of biochemical and psychosocial indicators in surgical patients with comorbid metabolic syndrome in gynecological practice. Materials and Methods. The authors conducted a prospective controlled study of 158 patients aged 18–45 with gynecological pathology requiring surgery and comorbid metabolic syndrome. All the patients underwent surgical treatment. All the patients were divided into two clinical groups according to perioperative management: Group 1 consisted of 82 patients who underwent laparoscopic operations with components of Fast Track surgery; Group 2 contained 76 patients who underwent laparoscopic operations according to the traditional management protocol. The examination of the patients included general surgical, clinical laboratory and psychometric methods. Results. The combined use of laparoscy and the basic methods of Fast Trak surgery helped to reduce the intensity of the endocrine-metabolic response to surgical trauma and the severity of psychoemotional distress, significantly increased the efficiency of surgical treatment and provided an earlier and more complete recovery of physical and psychological components of the quality of life of gynecological patients with comorbid metabolic syndrome. Conclusion. Fast Traсk surgery in laparoscopy in gynecological patients with comorbid metabolic syndrome contributed to an earlier recovery of biochemical markers of surgical stress, inflammatory-immune profile, and endothelium functional state. The psychosocial efficacy of Fast Trak surgery was confirmed by a reduction in hospital stay, earlier and complete recovery of physical and psychological components of patients’ quality of life. Keywords: surgical treatment, gynecological pathology, metabolic syndrome, Fast-Track surgery, neuro-immune-endocrine indicators, quality of life. Цель. Изучение влияния концепции Fast Track surgery на периоперационную динамику биохимических и психосоциальных показателей у пациенток хирургического профиля с коморбидным метаболическим синдромом в гинекологической практике. Материалы и методы. Выполнено проспективное контролируемое исследование 158 пациенток в возрасте от 18 до 45 лет с гинекологической патологией, требующей оперативного вмешательства, и коморбидным метаболическим синдромом, которым проведено хирургическое лечение. В зависимости от тактики периоперационного ведения больные были разделены на две клинические группы: 1-ю составили 82 пациентки, которым выполнены лапароскопические операции с применением компонентов концепции Fast Track surgery; 2-ю – 76 пациенток, которым выполнены лапароскопические операции с применением традиционного протокола ведения. Обследование пациенток включало общехирургический, клинико-лабораторный и психометрический методы. Результаты. Комбинированное применение лапароскопических операций и базовых компонентов мультимодальной концепции Fast Traсk surgery способствует снижению интенсивности эндокринно-метаболического ответа на операционную травму и выраженности психоэмоционального дистресса, значительно повышает эффективность хирургического лечения и обеспечивает более раннее и полноценное восстановление физического и психологического компонентов качества жизни гинекологических больных с коморбидным метаболическим синдромом. Выводы. Применение мультимодальной концепции Fast Traсk surgery при выполнении лапароскопических оперативных вмешательств у гинекологических больных с коморбидным метаболическим синдромом способствуют более раннему восстановлению уровня биохимических маркеров операционного стресса, воспалительно-иммунного профиля и функционального состояния эндотелия. Психосоциальная эффективность мультимодальной концепции Fast Traсk surgery подтверждается сокращением длительности пребывания в стационаре, более ранним и максимально полноценным восстановлением физического и психологического компонентов качества жизни пациенток. Ключевые слова: хирургическое лечение, гинекологическая патология, метаболический синдром, концепция Fast-Track surgery, нейро-иммунно-эндокринные показатели, качество жизни.

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Soong, BCP, KP Fan et HY Ng. « Psychometric Evaluation of Patient Satisfaction with a Fast Track Protocol Driven Service ». Hong Kong Journal of Emergency Medicine 23, n^o 2 (mars 2016) : 12–16. http://dx.doi.org/10.1177/102490791602300202.

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Zakhary, Waseem, E. W. Turton, A. Flo Forner, K. von Aspern, M. Borger et J. Ender. « Comparison of Remifentanil versus Sufentanil in context of Leipzig fast track protocol ». Journal of Cardiothoracic and Vascular Anesthesia 32 (août 2018) : S39. http://dx.doi.org/10.1053/j.jvca.2018.08.087.

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Rombeau, J. L. « Implementing Fast-Track Protocol for Colorectal Surgery : A Prospective Randomized Clinical Trial ». Yearbook of Gastroenterology 2010 (janvier 2010) : 214–15. http://dx.doi.org/10.1016/s0739-5930(10)79448-4.

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Kuster Uyeda, Maria Gabriela B., Manoel João Batista Castello Girão, Ébe dos Santos Monteiro Carbone, Marcelo Cunio Machado Fonseca, Mayara Ronzini Takaki et Marair Gracio Ferreira Sartori. « Fast-track protocol for perioperative care in gynecological surgery : Cross-sectional study ». Taiwanese Journal of Obstetrics and Gynecology 58, n^o 3 (mai 2019) : 359–63. http://dx.doi.org/10.1016/j.tjog.2019.02.010.

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Ionescu, Daniela, Cornel Iancu, Daniela Ion, Nadim Al-Hajjar, Simona Margarit, Lucian Mocan, Teodora Mocan, Delia Deac, Raluca Bodea et Horatiu Vasian. « Implementing Fast-Track Protocol for Colorectal Surgery : A Prospective Randomized Clinical Trial ». World Journal of Surgery 33, n^o 11 (26 août 2009) : 2433–38. http://dx.doi.org/10.1007/s00268-009-0197-x.

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Khare, Smith K. « Fast-track message authentication protocol for DSRC using HMAC and group keys ». Applied Acoustics 165 (août 2020) : 107331. http://dx.doi.org/10.1016/j.apacoust.2020.107331.

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Ender, Joerg, Michael Andrew Borger, Markus Scholz, Anne-Kathrin Funkat, Nadeem Anwar, Marcus Sommer, Friedrich Wilhelm Mohr et Jens Fassl. « Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit ». Anesthesiology 109, n^o 1 (1 juillet 2008) : 61–66. http://dx.doi.org/10.1097/aln.0b013e31817881b3.

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Background The authors compared the safety and efficacy of a newly developed fast-track concept at their center, including implementation of a direct admission postanesthetic care unit, to standard perioperative management. Methods All fast-track patients treated within the first 6 months of implementation of our direct admission postanesthetic care unit were matched via propensity scores and compared with a historical control group of patients who underwent cardiac surgery prior to fast-track implementation. Results A total of 421 fast-track patients were matched successfully to 421 control patients. The two groups of patients had a similar age (64 +/- 13 vs. 64 +/- 12 yr for fast-track vs. control, P = 0.45) and European System for Cardiac Operative Risk Evaluation-predicted risk of mortality (4.8 +/- 6.1% vs. 4.6 +/- 5.1%, P = 0.97). Fast-track patients had significantly shorter times to extubation (75 min [45-110] vs. 900 min [600-1140]), as well as shorter lengths of stay in the postanesthetic or intensive care unit (4 h [3.0-5] vs. 20 h [16-25]), intermediate care unit (21 h [17-39] vs. 26 h [19-49]), and hospital (10 days [8-12] vs. 11 days [9-14]) (expressed as median and interquartile range, all P < 0.01). Fast-track patients also had a lower risk of postoperative low cardiac output syndrome (0.5% vs. 2.9%, P < 0.05) and mortality (0.5% vs. 3.3%, P < 0.01). Conclusion The Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.

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Romagnoli, Daniele, Riccardo Schiavina, Lorenzo Bianchi, Marco Borghesi, Francesco Chessa, Federico Mineo Bianchi, Andrea Angiolini et al. « Is Fast Track protocol a safe tool to reduce hospitalization time after radical cystectomy with ileal urinary diversion ? Initial results from a single high-volume centre ». Archivio Italiano di Urologia e Andrologia 91, n^o 4 (14 janvier 2020) : 230–36. http://dx.doi.org/10.4081/aiua.2019.4.230.

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Introduction and aim: Radical Cystectomy (RC) with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track (FT) protocols have been described to reduce hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre. Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion. To validate its feasibility, we compared its results with data collected from a 1:1 matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol. Results: We enrolled in the FT group 11 (55%) patients scheduled to RC with ileal conduit diversion, and 9 patients (45%) scheduled to orthotopic neobladder (Studer) substitution, while a numerically equivalent population was enrolled in the control group, matched according to age at surgery, BMI, gender, ASA score, CCI, preoperative stage and type of urinary diversion. No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Median overall age was 71 years (Inter Quartile Range - IQR: 63-76) and mean operatory time was 276 ± 57 minutes. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain. We found no difference, in terms of both early and late complications ratio, among the two populations. Complications graded Clavien ≥ 3 were found in 4 patients of the control group (20%), while in only one patient (5%) in the Fast Track group, though this difference was not statistically significant. Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.

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Chughtai, Bilal, Christa Abraham, Daniel Finn, Stuart Rosenberg, Bharat Yarlagadda et Michael Perrotti. « Fast Track Open Partial Nephrectomy : Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome ». Advances in Urology 2008 (2008) : 1–5. http://dx.doi.org/10.1155/2008/507543.

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Introduction. The aim of this study is to examine the feasibility of reducing postoperative hospital stay following open partial nephrectomy through the implementation of a goal directed clinical management pathway.Materials and Methods. A fast track clinical pathway for open partial nephrectomy was introduced in July 2006 at our institution. The pathway has daily goals and targets discharge for all patients on the 3rd postoperative day (POD). Defined goals are (1) ambulation and liquid diet on the evening of the operative day; (2) out of bed (OOB) at least 4 times on POD 1; (3) removal of Foley catheter on the morning of POD 2; (4) removal of Jackson Pratt drain on the afternoon of POD 2; (4) discharge to home on POD 3. Patients and family are instructed in the fast track protocol preoperatively. Demographic data, tumor size, length of stay, and complications were captured in a prospective database, and compared to a control group managed consecutively immediately preceding the institution of the fast track clinical pathway.Results. Data on 33 consecutive patients managed on the fast track clinical pathway was compared to that of 25 control patients. Twenty two (61%) out of 36 fast track patients and 4 (16%) out of 25 control patients achieved discharge on POD 3. Overall, fast track patients had a shorter hospital stay than controls (median, 3 versus 4 days;P= .012). Age (median, 55 versus 57 years), tumor size (median, 2.5 versus 2.5 cm), readmission within 30 days (5.5% versus 5.1%), and complications (10.2% versus 13.8%) were similar in the fast track patients and control, respectively.Conclusions. In the present series, a fast track clinical pathway after open partial nephrectomy reduced the postoperative length of hospital stay and did not appear to increase the postoperative complication rate.

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Sulzer, Christopher F., René Chioléro, Pierre-Guy Chassot, Xavier M. Mueller et Jean-Pierre Revelly. « Adaptive Support Ventilation for Fast Tracheal Extubation after Cardiac Surgery ». Anesthesiology 95, n^o 6 (1 décembre 2001) : 1339–45. http://dx.doi.org/10.1097/00000542-200112000-00010.

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Background Adaptive support ventilation (ASV) is a microprocessor-controlled mode of mechanical ventilation that maintains a predefined minute ventilation with an optimal breathing pattern (tidal volume and rate) by automatically adapting inspiratory pressure and ventilator rate to changes in the patient's condition. The aim of the current study was to test the hypothesis that a protocol of respiratory weaning based on ASV could reduce the duration of tracheal intubation after uncomplicated cardiac surgery ("fast-track" surgery). Methods A group of patients being given ASV (group ASV) was compared with a control group (group control) in a randomized controlled study. After coronary artery bypass grafting during general anesthesia with midazolam and fentanyl, patients were randomly assigned to group ASV or group control. Both protocols were divided into three predefined phases, and weaning progressed according to arterial blood gas and clinical criteria. In phase 1, ASV mode was set at 100% of the theoretical value of volume/minute in group ASV, and synchronized intermittent mandatory ventilation mode was used in group control. When spontaneous breathing occurred, ASV setting was reduced by 50% of minute ventilation (phase 2) and again by 50% (phase 3), and the trachea was extubated. In group control, the ventilator was switched to 10 cm H2O inspiratory pressure support (phase 2), then to 5 cm H2O (phase 3) until extubation. Results Forty-nine patients were enrolled. Sixteen patients completed the ASV protocol, and 20 the standard protocol; 7 patients were excluded in group ASV and 6 in group control according to explicit, predefined criteria. There were no differences between groups in perioperative characteristics or in the doses of sedation. The primary outcome of the study, that is, the duration of tracheal intubation, was shorter in group ASV than in group control (median [quartiles]: 3.2 [2.5-4.6] vs. 4.1 [3.1-8.6] h; P < 0.02). Fewer arterial blood analyses were performed in group ASV (median number [quartiles]: 3 [3-4] vs. 4 [3-6]), suggesting that fewer changes in the settings of the ventilator were required in this group. Conclusions A respiratory weaning protocol based on ASV is practicable; it may accelerate tracheal extubation and simplify ventilatory management in fast-track patients after cardiac surgery. The evaluation of potential advantages of the use of such technology on patient outcome and resource utilization deserves further studies.

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Dobožinskas, Paulius, Rasa Valavičienė et Ami Hommel. « Changes In Care Management After “Fast Track” Protocol Introduction For Hip Fracture Patients ». Sveikatos mokslai 25, n^o 5 (30 novembre 2015) : 126–30. http://dx.doi.org/10.5200/sm-hs.2015.099.

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Background and objective. The introduction of fast track schemes for patients with hip fracture usually results in reductions in length of stay and mortality, and reduces the numbers of complications. The aim of this study was to evaluate the changes in proce�- dure performance, time from admission to surgery and length of stay after introduction of the fast track protocol (FTP). Materials and methods. 235 patients with hip fracture treated before FTP introduction and after the introduction were prospectively investigated. We studied the use of fracture immobilization, analgesics, infusion therapy, blood test sampling and ECG registration during these two periods. Information about the mean/median time period from admission to surgery and length of stay in the hospital (LOS) in the orthopaedic department was recorded. Results. Significant improvements in the use of im�- mobilization, infusion therapy, blood test sampling and ECG recording were observed after FTP introduction. Also significant reductions were observed in both waiting time for surgery and for LOS. Conclusion. Introduction of a FTP improved the use of procedures necessary for hip fracture patient care, while reducing wait to surgery time and LOS.

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Trevino, Colleen M., Karina M. Katchko, Amy L. Verhaalen, Marie L. Bruce et Travis P. Webb. « Cost Effectiveness of a Fast-Track Protocol for Urgent Laparoscopic Cholecystectomies and Appendectomies ». World Journal of Surgery 40, n^o 4 (15 octobre 2015) : 856–62. http://dx.doi.org/10.1007/s00268-015-3266-3.

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Larson, David W., Niles J. Batdorf, John G. Touzios, Robert R. Cima, Heidi K. Chua, John H. Pemberton et Eric J. Dozois. « A Fast-Track Recovery Protocol Improves Outcomes in Elective Laparoscopic Colectomy for Diverticulitis ». Journal of the American College of Surgeons 211, n^o 4 (octobre 2010) : 485–89. http://dx.doi.org/10.1016/j.jamcollsurg.2010.05.007.

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Behrns, K. E. « A Fast-Track Recovery Protocol Improves Outcomes in Elective Laparoscopic Colectomy for Diverticulitis ». Yearbook of Surgery 2011 (janvier 2011) : 266–67. http://dx.doi.org/10.1016/s0090-3671(10)79928-6.

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