Randomized Trial on Fast Track Care in Colorectal Surgery for Deep Infiltrating Endometriosis

Marco Scioscia, Marcello Ceccaroni, Irene Gentile, Gentile I, Rossini R, Roberto Rossini, Roberto Clarizia, Clarizia R, Brunelli D, Davide Brunelli, Giacomo Ruffo, Ruffo G
Journal of minimally invasive gynecology · 2017 · vol. 24(5) , pp. 815–821 · doi:10.1016/j.jmig.2017.04.004 · PMID:28435128 · W2606122702
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This randomized trial compared the outcomes of fast-track care versus standard care for patients undergoing colorectal surgery for deep infiltrating endometriosis.

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Abstract

Study objectiveTo study the application of a fast-track care protocol in colorectal surgery for deep infiltrating endometriosis. Bowel endometriosis is an infrequent but not rare condition that often needs intestinal surgery and imposes a high economic burden on society.DesignProspective randomized trial (Canadian Task Force classification I).SettingTertiary referral center.PatientsTwo hundred twenty-seven patients with preoperative evidence of bowel endometriosis.InterventionsWe randomly assigned 227 patients with preoperative evidence of bowel endometriosis to a fast-track protocol (no preoperative bowel preparation, early restoration of diet, no postoperative antibiotics, and early postoperative mobilization) or conventional care for laparoscopic intestinal surgery. Randomization was obtained on a double-blind, date-based schedule, and all procedures were performed by a homogenous group of expert surgeons. Surgical outcomes and a health economic evaluation were assessed.Measurements and main resultsThe primary outcome was hospital stay. Patient's well-being and intraoperative and postoperative complications up to 30 days after surgery were also assessed. Subsequently, direct medical costs were analyzed. Patients assigned to the fast-track protocol were discharged earlier (median 3 vs 7 days, p < .001) with no significant differences in subjective well-being (p = .55). Operative details, postoperative complications, and need of temporary ileostomy were similar (p = .89) between groups as well as readmission rates within 30 days (p = .69). The application of a fast-track protocol resulted in an overall significant reduction of costs (USD 6699 vs 8674, p < .01), and differences were more evident in cases of protective stoma (7652 vs 8793, p < .05) and surgery with postoperative complications (10 835 vs 14 005, p < .01).ConclusionThe application of a fast-track care protocol for laparoscopy in cases of pelvic and intestinal endometriosis does not increase the risk of complications and ensures a reduction of medical costs.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Colon Colorectal Surgery Critical Pathways Critical Pathways Critical Pathways Endometriosis Intestinal Diseases Rectum Adult Colon Colorectal Surgery Colorectal Surgery Colorectal Surgery Double-Blind Method Endometriosis Endometriosis Female Humans Ileostomy Ileostomy

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