Patient outcomes of a post-anaesthesia fast-track pathway after outpatient surgery: A systematic review

Advances in surgical and anaesthetic techniques have enabled some outpatients to meet the criteria for discharge from the Post-Anaesthetic Care Unit while still in the operating room. These patients may benefit from being transferred directly from the operating room to a dedicated recovery area designed to expedite discharge home-a concept known as fast-tracking. Although this innovative approach to postoperative nursing care has already been implemented in clinical practice, its impact on patient outcomes and patient safety remains uncertain.

This systematic review aims to evaluate the effectiveness of a fast-track pathway compared to the standard recovery pathway after outpatient surgery.

The databases MEDLINE, Embase, Web of Science, CINAHL, Cochrane and Scopus were searched until January 2025.

The review included randomised-controlled trials, case-control studies, prospective and retrospective cohort studies that reported on fast-tracking of adult patients undergoing outpatient surgical procedures. Two reviewers independently assessed the eligibility of the articles identified with the search strategy. The risk of bias was assessed with the Risk of Bias 2 tool for randomised-controlled trials and the Risk of Bias in Non-randomised studies of Interventions for non-randomised controlled trials. Due to the heterogeneity of the included studies, a narrative synthesis was conducted to systematically summarise and interpret the findings across studies.

The literature search identified 5226 unique records, with 7 studies of low quality and high risk of bias included in this review. 5 of the 7 studies were published before 2005. Bypass rates varied from 30 % to 87 %. All included studies reported a shorter postoperative length of stay for the fast-track group compared to the standard recovery pathway. The studies indicated that fast-tracked patients had similar, or in some cases, even better outcomes regarding readmission rates and the incidence of postoperative adverse effects compared to the standard recovery pathway.

Not all patients require admission to the Post-Anaesthetic Care Unit after outpatient surgery. Fast-tracking certain patients may offer benefits, such as a shorter postoperative length of stay, without negatively impacting patient outcomes. By reducing length of stay, improving patient flow and optimising resource utilisation, fast-tracking has the potential to enhance the efficiency and organisation of care while maintaining the quality. However, high-quality studies are needed to evaluate the safety and effectiveness of fast-tracking. As fast-tracking combines the care environments of the Post-Anaesthetic Care Unit and phase II recovery units, tailored nursing care for fast-track patients may be necessary.

CRD4202452974, PROSPERO, Registered 23/03/2024.