Fast-track Implementing Experience in the Kyrgyz Republic

Abstract

Fast Track Pathways (FTP) aimed at reducing length of stay and overall costs are increasingly being implemented for emergency surgeries. The objective of this study was to evaluate the implementation of a FTP for emergency general surgery at the Osh State University Clinical Hospital (OSU CH). The study included 98 patients at OSU CH from 2020 to 2023 who underwent laparoscopic appendectomy (LA), laparoscopic cholecystectomy (LC), or laparoscopic inguinal hernia repair (LI). The FTP group comprised 71 patients, with data from 76 control cases assessed prior to FTP implementation. Comparisons were made between time to surgery (TTS), length of stay (LOS), and total length of stay between groups. Direct costs, reimbursements, and patient satisfaction (rated from 1 = never to 4 = always) were also evaluated. The sample comprised 60.6% females with a median age of 40 years. Case distribution varied slightly (56.2% vs 42.1% for LA, 40.4% vs 57.9% for LC, FTP vs control), yet time to surgery was similar between groups (11 hours 39 minutes vs 10 hours 2 minutes, P = 0.633). Postoperative LOS was significantly shorter in the FTP group (15 hours 17 minutes vs 29 hours 9 minutes, P < 0.001), reflecting reduced hospital stay (3 hours 11 minutes vs 20 hours 10 minutes, P < 0.001), with fewer patients requiring inpatient beds and overnight stays (P < 0.001). Direct costs were significantly reduced in the FTP group, while reimbursements were comparable (P < 0.001 and P = 0.999, respectively), and average patient satisfaction was high (3.3/4). In an era of cost reduction, resource optimization, and patient satisfaction, FTP can play a significant role in emergency hospitalization. At OSU CH, FTP significantly reduced hospital stay and bed utilization without impacting reimbursements or patient satisfaction.