Kariv Y et al. (2007) Clinical outcomes and cost analysis of a “fast track” postoperative care pathway for ileal pouch-anal anastomosis. A case control study. Dis Colon Rectum 50: 137–146

Patients who undergo open ileal-pouch–anal anastomosis (IPAA) are normally hospitalized for 8–15 days, because this procedure is complex. A new case–control study has shown, however, that use of a fast-track patient rehabilitation protocol characterized by early postoperative feeding and ambulation after IPAA substantially reduces the duration and costs of hospital stay, without increases in readmission and complication rates.

Kariv and colleagues retrospectively compared the perioperative results, direct costs of hospital care, 30-day and long-term complication rates of 97 patients who underwent primary open IPAA and were managed according to a fast-track rehabilitation protocol, with those of 97 controls (matched for age, sex, surgery and presence of diverting ileostomy) who were managed by traditional care.

Hospital costs were reduced by US$980 for fast-tracked patients, principally because their hospital stay was shorter than that of traditionally managed patients (median 4 versus 5 days). Substantially more fast-tracked than traditionally managed patients were discharged within 3, 4 or 5 days after IPAA. Readmission and complication rates within 10 days and 30 days of surgery, and patient outcomes over a median follow-up of 20 months, were similar for both groups.

The 24 fast-tracked patients who required >5 days hospitalization were predominantly male, and had increased rates of anastomotic complications and reoperations. Kariv and colleagues suggest that successful discharge within 5 days might predict a favorable outcome and benign postoperative course after IPAA.