Implementation of laparoscopic colectomy with fast-track care in an academic medical center: benefits of a fully ascended learning curve and specialty expertise

被引：36

作者：

Bosio, Raul M. ^{[1
]}

Smith, Bryan M. ^{[1
]}

Aybar, Pablo Serrano ^{[1
]}

Senagore, Anthony J. ^{[1
]}

机构：

[1] Univ Toledo, Dept Surg, Toledo, OH 43614 USA

来源：

AMERICAN JOURNAL OF SURGERY | 2007年 / 193卷 / 03期

关键词：

Laparoscopic colectomy; length of stay; cost analysis;

D O I：

10.1016/j.amjsurg.2006.09.019

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: There are few data describing successful institutional "conversion" from open colectomy/standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P < .001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days; $4,993 vs. $11,383; both P < .001.). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures. (c) 2007 Excerpta Medica Inc. All rights reserved.

引用

页码：413 / 415

页数：3

共 33 条

[1] Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch anal anastomosis [J].