Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Lemmens, Lidwien C.; Zelm, Ruben van; Rinkes, Inne Borel; Hillegersberg, Richard van; Kerkkamp, H. E. M.

doi:10.1159/000206142

Cited by 55 publications

(58 citation statements)

References 73 publications

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“…41 Relative to being used successfully and maturely in colorectal surgery, FT programs are performed infrequently in other types of surgery such as hepatic resection.…”

Section: Discussionmentioning

confidence: 99%

Fast-Track Programs for Liver Surgery: A Meta-Analysis

Xiong

et al. 2015

Journal of Gastrointestinal Surgery

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“…41 Relative to being used successfully and maturely in colorectal surgery, FT programs are performed infrequently in other types of surgery such as hepatic resection.…”

Section: Discussionmentioning

confidence: 99%

Fast-Track Programs for Liver Surgery: A Meta-Analysis

Xiong

et al. 2015

Journal of Gastrointestinal Surgery

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“…2 Enhanced recovery after surgery (ERAS) is associated with a shortened hospital stay and minimal morbidity. [4][5][6][7] A meta-analysis of surgically placed wound catheters (SPWCs) for the management of postoperative pain after breast surgery looked at 4 randomised controlled trials (RCTs) including a total of 147 women. 8 This study showed a trend towards improved pain control.…”

Section: Discussionmentioning

confidence: 99%

Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

Chaudhry

Hallam

Chambers

et al. 2015

annals

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INTRODUCTION Postoperative pain after breast surgery is one of the major factors contributing to delay in mobilisation and prolonged hospital stay. A retrospective analysis was performed of patients undergoing skin sparing mastectomy and insertion of a subpectoral implant. The aim was to determine whether the use of an elastomeric local anaesthetic pump improved pain control and length of stay. METHODS Twenty-five consecutive patients undergoing the above procedure were sited with an elastomeric local anaesthetic infusion pump intraoperatively, in addition to standard regular and pro re nata analgesia. The control group comprised 25 patients undergoing the same procedure in the same year who received standard analgesia alone. Visual analogue scale scores were recorded for the duration of inpatient stay, as was any further analgesic requirement. RESULTS The median age was 51 years (range: 26-75 years) in the intervention group and 50 years (range: 28-70 years) in the control group. The mean visual analogue scale score was 0.28 (standard deviation [SD]: 0.61) at 24 hours for the intervention group and 1.84 (SD: 0.37) for the control group (p<0.0001). The mean length of stay was 1.8 days (SD: 0.71 days) for the intervention group and 2.28 days (SD: 0.94 days) for the control group (p=0.15). There were no complications involving catheter placement, leakage or toxicity relating to use of the local anaesthetic. CONCLUSIONS There was significantly reduced pain with the use of the local anaesthetic infusion pump. The elastomeric pump is a step towards enhanced patient recovery after breast surgery in the case of skin sparing mastectomy and subpectoral tissue expander reconstruction.

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“…These process improvement tools have gained popularity in many different surgical settings [24][25][26][27] . Most have been developed and implemented at an institutional level 24 .…”

Section: Discussionmentioning

confidence: 99%

Surgical Process Improvement Tools: Defining Quality Gaps and Priority Areas in Gastrointestinal Cancer Surgery

et al. 2014

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Background: Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. Methods: The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. Results: The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Conclusions: Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery.

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Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Cited by 55 publications

References 73 publications

Fast-Track Programs for Liver Surgery: A Meta-Analysis

Fast-Track Programs for Liver Surgery: A Meta-Analysis

Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

Surgical Process Improvement Tools: Defining Quality Gaps and Priority Areas in Gastrointestinal Cancer Surgery

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