Background
“Fast-track” surgery, involving multimodal care, improves efficiency and short-term
outcomes in patients undergoing bowel resection. The sustainability of the benefits
and the “drag” effect on non-participating surgeons through changed nursing and resident
practice is undetermined.
Methods
297 consecutive elective colon resections (DRG149) within three study periods (pre-change,
immediate post-change, long-term post-change) were retrospectively reviewed. Two surgeons
began to “fast-track” their patients in 1999 independently from the other surgeons
in the hospital. Surgeons were grouped into “fast-track surgeons,” “high-volume surgeons,”
(≥10 cases per year) and “low-volume surgeons,” (<10 cases per year). Comparisons
of duration of stay (DOS), readmission rates, and mortality were made for each of
three time periods and surgeon groups. Trends were also compared with unrelated hospital
non-colectomy control groups (uncomplicated craniotomy DRG 001 and pancreatic surgery
DRG 192) and to a colectomy control group from a statewide database (DRG 149).
Results
Mean DOS for colon resection significantly decreased among the “fast-track” surgeons
and among all the other surgeons in the hospital, from 6.3 ± 0.3 days, down to 3.7
± 0.1 days. We found no significant difference in mortality or readmission rates between
the study periods. 15% of the cases were performed laparoscopically, and the improvements
in outcome were independent of surgical technique. Control group analyses demonstrated
that the environmental impact on outcome was independent of hospital-wide or regional
improvement efforts.
Conclusions
Implementation of a new practice pattern in a shared environment leads to improved
outcomes for patients of other surgeons within the same environment. Dissemination
and cross-pollination of new methods through resident, nurse, and case manager practice
pattern modification creates a favorable force for change and this impact is sustained
over a 3-year period.
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Article info
Publication history
Accepted:
March 25,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
