Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer

So, Jimmy Bok Yan; Lim, Z.L.Ryan; Lin, Heng An; Ti, Thiow Kong

doi:10.1007/s10120-008-0458-7

Cited by 36 publications

(37 citation statements)

References 15 publications

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“…There were 11 articles (1,128 patients) on fast track oesophageal surgery [11][12][13][14][15][16][17][18][19][20][21] and 7 (329 patients) on fast track gastric surgery. 12,[22][23][24][25][26][27] Ten articles were case series, five were case-controlled studies and three were RCTs (all gastrectomy related with a Jadad score of 1 or 2). All articles involved single centre data, most being small volume.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Gemmill

Humes

Catton

2015

annals

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INTRODUCTION Fast track methodology or enhanced recovery schemes have gained increasing popularity in perioperative care. While evidence is strong for colorectal surgery, its importance in gastric and oesophageal surgery has yet to be established. This article reviews the evidence of enhanced recovery schemes on outcome for this type of surgery. METHODS A systematic literature search was conducted up to March 2014. Studies were retrieved and analysed using predetermined criteria. RESULTS From 34 articles reviewed, 18 eligible studies were identified: 7 on gastric and 11 on oesophageal resection. Three randomised controlled trials, five case-controlled studies and ten case series were identified. The reported protocols included changes to each stage of the patient journey from pre to postoperative care. The specific focus following oesophageal resections was on early mobilisation, a reduction in intensive care unit stay, early drain removal and early (or no) contrast swallow studies. Following gastric resections, the emphasis was on reducing epidural anaesthesia along with re-establishing oral intake in the first three postoperative days and early removal of nasogastric tubes. In the papers reviewed, mortality rates following fast track surgery were 0.8% (9/1,075) for oesophageal resection and 0% (0/329) for gastric resection. The reported morbidity rate was 16.5% (54/329) following gastric resection and 38.6% (396/1,075) following oesophageal resection. Length of stay was reduced in both groups compared with conventional recovery groups in comparative studies. CONCLUSIONS The evidence for enhanced recovery schemes following gastric and oesophageal resection is weak, with only three (low volume) published randomised controlled trials. However, the enhanced recovery approach appears safe and may be associated with a reduction in length of stay.

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Section: Resultsmentioning

confidence: 99%

“…14,21,22,25,27 All reported cost reduction. On the other hand, no detailed economic analysis was performed and they were limited to in-hospital costs.…”

Section: Limitationsmentioning

confidence: 99%

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Gemmill

Humes

Catton

2015

annals

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“…As the country with the highest gastric cancer risk in the world (Yamamoto, 2001), Japan' study (So, et al, 2008) resented that reduction in ALOS and inpatient expenditures were associated to CPW for gastric cancer. In addition, a cohort study in Japan also showed CPW can decrease ALOS considerably for colorectal cancer (Ishiguro et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Could Clinical Pathways Improve the Quality of Care in Patients with Gastrointestinal Cancer? A Meta-analysis

Song

Tian²,

Cui³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…From a maximum of nine stars, three studies achieved 7 stars and were deemed high quality [8,10,14]. The remaining two studies scored 5 and 6 stars respectively [3,7]. Risk of bias assessment for randomized trials is shown in Table 3.…”

Section: Study Qualitymentioning

confidence: 99%

“…Nine studies were randomized trials [2,4e6,9,11e13], and the remaining five were cohort studies [3,7,8,10,14], of which three compared prospectively collected ERP and control data [7,8,10], one compared prospectively collected ERP data with retrospectively collected control data [3], the fifth collecting purely retrospective data [14].…”

Section: Study Characteristicsmentioning

confidence: 99%

Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery

Beamish

Chan

Blake

et al. 2015

International Journal of Surgery

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This systematic review and meta-analysis was performed to determine the influence of enhanced recovery programmes (ERPs) on outcomes after gastric cancer surgery. Medline, Embase, the Cochrane library and ClinicalTrials.gov were searched for studies on outcomes of gastrectomy in enhanced recovery or fast-track programmes. The primary outcome measure was post-operative duration of hospital stay (LOHS), and secondary outcome measures were selected based inclusion in two or more studies. Statistical analysis was performed using standardized mean difference (SMD) and odds ratio (OR) as the summary statistics. Fourteen studies, totalling 1676 patients with gastric cancer were analysed, including nine randomized trials. LOHS was significantly shorter after ERP when compared with control patients (CON, SMD -1.10, 95% confidence interval -1.56 to -0.65, p < 0.001), but with significant heterogeneity between studies (I(2) = 93%, p < 0.001). ERP was also associated with reduced serum inflammatory response (CRP: SMD -0.68 (-1.16 to -0.19), p = 0.007; IL-6: SMD -0.62 (-0.94 to -0.29), p < 0.001), less weight loss (SMD -0.79 (-1.11 to -0.46), p < 0.001), and lower cost (SMD -1.02 (-1.59 to -0.45), p < 0.001), as well as a trend toward shorter duration of intravenous infusion (SMD -2.70 (-5.35 to -0.05), p = 0.05). Inclusion in an ERP was not associated with increased post-operative morbidity (OR 0.83 (0.65 to 1.06), p = 0.13) or hospital readmission (OR 1.67 (0.88 to 3.19), p = 0.12). From this review the authors concluded that multimodal, standardized perioperative gastrectomy care appears feasible, safe and cost effective.

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Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancer

Cited by 36 publications

References 15 publications

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Systematic review of enhanced recovery after gastro-oesophageal cancer surgery

Could Clinical Pathways Improve the Quality of Care in Patients with Gastrointestinal Cancer? A Meta-analysis

Systematic review and meta-analysis of enhanced recovery programmes in gastric cancer surgery

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