Use of a Critical Pathway for Colon Resections

Melbert, R. Barry; Kimmins, Mark H.; Isler, John T.; Billingham, Richard P.; Lawton, D E B; Salvadalena, Ginger; Cortezzo, Mark; Rowbotham, Ron

doi:10.1016/s1091-255x(02)00038-0

Cited by 40 publications

(36 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1) [19,20,21,22,23,24,25,26,27,28,29,30,31]. Seven (54%) of the 13 articles concerned studies about the evaluation of clinical pathways in the USA, 2 (15%) Germany, 2 (15%) Japan, 1 (8%) concerned Denmark, and 1 (8%) concerned Singapore.…”

Section: Resultsmentioning

confidence: 99%

“…In 11 of the 13 studies evaluating clinical pathways (85%) a statistically significant decrease in length of stay was observed [19,20,21,22,23,24,25,26,27,28,29]. With regard to complication rates, re-admission rates and mortality, in most studies no significant differences [21,22,23,24,25,26,27,28,29, 31] and sometimes positive effects [19, 20, 30] are observed between the conventional care and pathway groups. It can therefore be argued that patients can be safely treated according to the clinical pathway as the reported decrease in length of stay does not seem to have any adverse effects on the other three outcome measures.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lemmens

Zelm²,

Rinkes

et al. 2009

Dig Surg

View full text Add to dashboard Cite

Background/Aims: Oncology surgery of the gastrointestinal tract is complex and infamous for its high complication rates. One of the methods for implementing interventions to optimize the patients’ condition and to enhance postoperative outcome is the development and implementation of a clinical pathway. The aim of this study was to analyze the content, i.e. the interventions of clinical pathways for digestive surgery and their effects on postoperative outcome measures. Methods: We performed a systematic review to study clinical pathways in hospital care for adult patients undergoing elective surgery of the stomach, esophagus, pancreas, liver, colon or rectum. The MEDLINE, EMBASE and CINAHL literature databases were searched. Results: The most common interventions in the clinical pathways in this review were defined in the pre- and postoperative phase and included: nutritional management, pain management, mobilization, education and discharge planning. The primary aim of these interventions was to enhance postoperative recovery. Conclusion: Clinical pathways for digestive surgery contain specific interventions to improve postoperative outcome. Most of these interventions are in accordance with the Enhanced Recovery After Surgery (ERAS) protocol, which is an evidence-based protocol for care after colon resections. They result in reduced length of stay without compromising other postoperative outcome measures.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Lemmens

Zelm²,

Rinkes

et al. 2009

Dig Surg

View full text Add to dashboard Cite

show abstract

“…Most studies are focusing on one single operation and on length of hospital stay [6][7][8][9][10][11][12][13][14][15] ( Table 4). Costs were only analyzed with the help of general model calculations and resource utilization was not analyzed in detail [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…In surgery, the impact of clinical pathways on resource utilization remains unclear. A few studies are available, but are restricted to a single procedure, and cost analyses are mainly based on the length of hospital stay [6][7][8][9][10][11][12][13][14][15] (see Table 4). Most studies come from the US [16] and two thirds of studies on clinical pathways were classified as of low quality [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of clinical pathways in surgery

Müller

Dedes

Dindo

et al. 2008

Langenbecks Arch Surg

View full text Add to dashboard Cite

Background One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities. Method Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65). Results Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p<0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from € 6,390 to € 4,800 (p<0.001). Costs for diagnostic tests were reduced by 33% (p<0.001). Nursing hours decreased, reducing nursing costs by 24% from € 1,810 to € 1,374 (p<0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07). Conclusions This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.

show abstract

“…Standardized perioperative care plans have been shown to minimize variations in perioperative care, and may potentially influence hospital length of stay and patient morbidity. 21,22 In conclusion, when patients receive PCA morphine for postoperative analgesia, and a traditional surgical and nursing perioperative care program is implemented, a laparoscopic approach to colectomy accelerates return of bowel function and shortens length of hospital stay in comparison to colectomy performed by laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopy for colectomy accelerates restoration of bowel function when using patient controlled analgesia

Hong

Mistraletti

Zandi

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: A standardized care plan incorporating patient-controlled analgesia with iv morphine and a non-accelerated feeding schedule following colectomy was used to compare return of bowel function and hospital discharge times following surgery done by laparoscopy or laparotomy. Methods:Thirty-eight patients were assigned to undergo either laparoscopic or laparotomy colon resection. Postoperative analgesia was achieved with patient-controlled analgesia with iv morphine. General anesthesia and perioperative care were standardized, and a traditional surgical and nursing care program was implemented. Gastrointestinal function (time from surgery to return of passage of flatus and presence of bowel movements), pain intensity (visual analogue scale) at rest, on coughing and on mobilization, amount of morphine used, and criteria for discharge and length of hospital stay were recorded.Results: Bowel movements resumed earlier in the laparoscopic group (P < 0.05), but not passage of flatus. No significant relationship was found between the amount of morphine used and return of bowel function. Cumulative morphine consumption during the first two postoperative days was similar in both groups. Where a trend towards lower postoperative visual analogue scale scores was observed in the laparoscopic group, visual analogue scale scores on coughing were lower in the laparoscopic vs laparotomy group only during the first 24 hr (P < 0.05). Length of hospital stay was significantly shorter in the laparoscopic group (P < 0.05), although times to meet discharge criteria were similar in both groups. Conclusions:When patient-controlled analgesia with morphine and a traditional perioperative program are used, a laparoscopic approach to colon surgery promotes earlier restoration of bowel function and more rapid hospital discharge in comparison to resection by laparotomy. Objectif : Un plan de soins normalisé comportant l'analgésie autocontrôlée avec de la morphine iv et un programme d'alimentation

show abstract

Use of a Critical Pathway for Colon Resections

Cited by 40 publications

References 15 publications

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

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

Impact of clinical pathways in surgery

Laparoscopy for colectomy accelerates restoration of bowel function when using patient controlled analgesia

Contact Info

Product

Resources

About