EVAR FAST-TRACK, THE IMPLEMENTATION OF A SAFE AND COST-EFFECTIVE PROTOCOL

Abstract

Objective

To evaluate and confirm the cost effectiveness and safety of a fast-track protocol discharge of patients after standard EVAR.

Material and Methods

A total of 83 patients admitted for standard EVAR procedure were collected in a database. The experimental group included 40 patients treated after the establishment of a fast-track EVAR protocol (from April 2020 to April 2023) in our hospital. The control group included 43 patients, standard admission, treated before 2020 (from January 2017 to December 2019).

No differences were found in main demographic and clinical characteristics in both groups. We collected data on the length of hospital stay and the costs derived from it, the need for re-intervention and the occurrence of major adverse events. We did a follow-up after 30 days and six months after the intervention.

Results

There were no changes in clinical indication or surgical procedures between both groups. The only difference was related to the fast-track protocol itself. We observed a shorter hospital stay (2.3 vs 3.7 days p<0.001), less need for monitoring in the resuscitation unit (0.2 vs 1.1 days p<0.001) and lower rate of secondary intervention in the experimental group (fast-track group). In postoperative follow-up, the fast-track group also presented lower readmission rate for any reason (12.5% vs. 23.3%), that could be explained because of the shorter hospital stay at primary admission, lowering complications derived from it. The total cost per patient for the health system during the hospital admission was 1403.29 ± 820.3 euros in the experimental group and 3339.34 ± 2513.1 euros in the control group, resulting in a total saving per patient of 1936.05 euros (95% CI 2748.12 - 1123.97) in the fast-track group.

Conclusions

The implementation of a fast-track protocol for patients undergoing standard EVAR, results in a shorter hospital stay lowering perioperative costs, without increasing adverse events or readmission rate following discharge. Therefore, its practice should be considered as standard of care in patients admitted for EVAR procedure.