Gynecologic Disease Clinical Trial
Official title:
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 ;
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