Impact of abdominal fast-track on the treatment efficiency and prognosis of acute abdomen

Objective: This objective is to evaluate the impact of the abdominal fast-track (AFT), implemented in March 2023 at our institution, on treatment efficiency and clinical outcomes in acute abdomen (AA) patients. Methods: A retrospective analysis was conducted based on outcomes of 513 AA patients admitted from June 2021 to April 2024. Patients were grouped according to their admitted time into the pre-AFT group (June 2021–February 2023, n = 197) in which patients were managed under conventional consultation protocols, or the AFT group (March 2023–April 2024, n = 316). Baseline characteristics, time intervals (from emergency department [ED] arrival to admission, admission to surgical request, surgical request to surgery initiation, operative duration, and length of hospital stay), postoperative complications, and 30-day mortality rates were compared between the two groups. Results: The AFT group demonstrated a 39.8% reduction in median time from ED arrival to surgery initiation (19.25 h vs. 11.58 h, P < 0.001) and a 10.8% decrease in admission to surgery request time (0.83 h vs. 0.74 h, P = 0.047) than those of the pre-AFT group. Total hospitalization duration of the AFT group was reduced by 42.6% (7.95 vs. 4.56 days, P < 0.001), with concomitant declines in postoperative pneumonia (3.6% vs. 0.6%, P = 0.031) and intra-abdominal infections (5.6% vs. 1.6%, P = 0.011). Severe complications (Clavien–Dindo grade ≥3) decreased from 16.8% to 5.1% ( P < 0.001). The AFT increased nighttime surgical interventions (18:00-08:00) from 44.7% to 67.1% ( χ 2 = 25.118, P < 0.001) and elevated the proportion of surgeries performed by attending physicians/junior surgeons under senior supervision from 74.0% to 89.9% ( χ 2 = 50.783, P < 0.001). Conclusion: The impact of AFT can shorten preoperative waiting time and improve overall outcomes in AA patients.