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Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery
OBJECTIVE: Discharge policies concerning hospitalization after endoscopic pituitary tumor surgery are highly variable. A few studies support fast-track discharge; however, this is not commonplace. Our goal was to report the transition to and evaluate the feasibility, safety, clinical- and patient-re...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343751/ https://www.ncbi.nlm.nih.gov/pubmed/32361869 http://dx.doi.org/10.1007/s12020-020-02308-2 |
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author | Lobatto, Daniel J. Vliet Vlieland, Thea P. M. van den Hout, Wilbert B. de Vries, Friso de Vries, Anne F. Schutte, Pieter J. Verstegen, Marco J. T. Pereira, Alberto M. Peul, Wilco C. Biermasz, Nienke R. van Furth, Wouter R. |
author_facet | Lobatto, Daniel J. Vliet Vlieland, Thea P. M. van den Hout, Wilbert B. de Vries, Friso de Vries, Anne F. Schutte, Pieter J. Verstegen, Marco J. T. Pereira, Alberto M. Peul, Wilco C. Biermasz, Nienke R. van Furth, Wouter R. |
author_sort | Lobatto, Daniel J. |
collection | PubMed |
description | OBJECTIVE: Discharge policies concerning hospitalization after endoscopic pituitary tumor surgery are highly variable. A few studies support fast-track discharge; however, this is not commonplace. Our goal was to report the transition to and evaluate the feasibility, safety, clinical- and patient-reported outcomes and costs of fast-track care in pituitary surgery. METHODS: This observational study included 155 patients undergoing pituitary surgery between December 2016 and December 2018. Fast-track care consisted of planned discharge 2–3 days after surgery, followed by daily surveillance by a case manager. All outcomes were compared with patients not eligible for fast-track discharge. The total group (fast-track and non-fast-track) was compared with historic controls (N = 307). RESULTS: A total of 79/155 patients (51%) were considered eligible for fast-track discharge, of whom 69 (87%) were discharged within 3 days. The total group was discharged more often within 3 days compared with historic controls (49 vs. 20%, p < 0.001), the total length of stay did not differ (5.3 vs. 5.7 days, p = 0.363). Although the total group had more readmissions compared with historic controls (17 vs. 10%, p = 0.002), no life-threatening complications occurred after discharge. On average, clinical- and patient-reported outcomes improved over time, both in the fast-track and non-fast-track groups. The mean overall costs within 30 days after surgery did not differ between the total group € 9992 (SD € 4562) and historic controls € 9818 (SD € 3488) (p = 0.649). CONCLUSION: A stratified fast-track care trajectory with enhanced postoperative outpatient surveillance after pituitary tumor surgery is safe and feasible. As expected, costs of the fast-track were lower than the non-fast-track group, however we could not prove overall cost-effectiveness compared with the historic controls. |
format | Online Article Text |
id | pubmed-7343751 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-73437512020-07-13 Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery Lobatto, Daniel J. Vliet Vlieland, Thea P. M. van den Hout, Wilbert B. de Vries, Friso de Vries, Anne F. Schutte, Pieter J. Verstegen, Marco J. T. Pereira, Alberto M. Peul, Wilco C. Biermasz, Nienke R. van Furth, Wouter R. Endocrine Original Article OBJECTIVE: Discharge policies concerning hospitalization after endoscopic pituitary tumor surgery are highly variable. A few studies support fast-track discharge; however, this is not commonplace. Our goal was to report the transition to and evaluate the feasibility, safety, clinical- and patient-reported outcomes and costs of fast-track care in pituitary surgery. METHODS: This observational study included 155 patients undergoing pituitary surgery between December 2016 and December 2018. Fast-track care consisted of planned discharge 2–3 days after surgery, followed by daily surveillance by a case manager. All outcomes were compared with patients not eligible for fast-track discharge. The total group (fast-track and non-fast-track) was compared with historic controls (N = 307). RESULTS: A total of 79/155 patients (51%) were considered eligible for fast-track discharge, of whom 69 (87%) were discharged within 3 days. The total group was discharged more often within 3 days compared with historic controls (49 vs. 20%, p < 0.001), the total length of stay did not differ (5.3 vs. 5.7 days, p = 0.363). Although the total group had more readmissions compared with historic controls (17 vs. 10%, p = 0.002), no life-threatening complications occurred after discharge. On average, clinical- and patient-reported outcomes improved over time, both in the fast-track and non-fast-track groups. The mean overall costs within 30 days after surgery did not differ between the total group € 9992 (SD € 4562) and historic controls € 9818 (SD € 3488) (p = 0.649). CONCLUSION: A stratified fast-track care trajectory with enhanced postoperative outpatient surveillance after pituitary tumor surgery is safe and feasible. As expected, costs of the fast-track were lower than the non-fast-track group, however we could not prove overall cost-effectiveness compared with the historic controls. Springer US 2020-05-02 2020 /pmc/articles/PMC7343751/ /pubmed/32361869 http://dx.doi.org/10.1007/s12020-020-02308-2 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article Lobatto, Daniel J. Vliet Vlieland, Thea P. M. van den Hout, Wilbert B. de Vries, Friso de Vries, Anne F. Schutte, Pieter J. Verstegen, Marco J. T. Pereira, Alberto M. Peul, Wilco C. Biermasz, Nienke R. van Furth, Wouter R. Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
title | Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
title_full | Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
title_fullStr | Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
title_full_unstemmed | Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
title_short | Feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
title_sort | feasibility, safety, and outcomes of a stratified fast-track care trajectory in pituitary surgery |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343751/ https://www.ncbi.nlm.nih.gov/pubmed/32361869 http://dx.doi.org/10.1007/s12020-020-02308-2 |
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