J. Carter et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 1-5
4
be discharged on day 2, setting the benchmark for all
others following the principals of FTS to aspire to. Our
findings are similar to Chase et al, in that younger age,
ovarian tumours, benign pathology, transverse skin inci-
sions, decreased operating time, early oral feeding, use
of COX II inhibitors and net haemoglobin change were
all significantly different in the early discharge group
when compared to the group of patients discharged after
day 2. In addition, with our greater experience, we have
found in our third year after adopting FTS principles,
31.4% of our patients can now be discharged on day 2.
We did not find insurance status, weight, BMI or esti-
mated blood loss to be significantly different between
the groups.
Both Chase et al and our own group have questioned
the reported perceived benefits of laparoscopic surgery
in light of results achieved with FTS laparotomy [6,10].
Recent evidence from the GOG LAP2 study support our
position. This is the largest prospective randomized
study in the world comparing laparoscopic surgery for
endometrial cancer to non-fast tracked laparotomy pa-
tients. In summary there were similar rates of in-
tra-operative complications, with a significant number of
patients converted to laparotomy due to poor visibility,
metastatic cancer or bleeding. Median LOS of non-fast
tracked laparotomy patients was 4 days and 3 days for
laparoscopy patients [11]. Furthermore, whilst quality of
life (QOL) was enhanced across many parameters in the
laparoscopy group at 6 weeks, these differences were not
significant by 6 months. Whilst cross trial comparisons
are statistically invalid, one can only speculate whether
the 1 day difference in LOS would be negated if the
laparotomy patients in this study were fast tracked [12].
Similar results have also b een publish ed by Mouritis and
colleagues [13] who have reported a median LOS of 5
days for their non-fast tracked hysterectomy patients
compared to 2 days for laparoscopic hysterectomy pa-
tients and no difference in major complication rate.
Further enhancements to our FTS program which will
allow a greater proportion of patients to be safely dis-
charged on day 2 include enhancing preoperative con-
sultations to further emphasise the rationale of FTS and
encouraging patients to contribute by agreeing to dis-
charge when medically appropriate. A number of our
patients discharged on day 3 could have been discharged
on day 2 had there been appropriate supervision at home
on discharge. Improving GI function is also an area we
have identified as worthy of further study. Simple tech-
niques such as initiating a regular chewing gum regimen
after surgery to stimulate bowel function has been sh own
to be effective and would add little financial impost and
minimal risk of increased morbidity [14-19]. Health care
organisations and Hospital Administrators also derive
significant financial benefit from a FTS program and
should provide funding for the initiation and mainte-
nance of such programs.
This study has shown that with experience over 30%
patients undergoing laparotomy on a FTS program, can
be safely discharged on day 2 without an increase in the
readmission rate or morbidity.
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