Clinical Pathways for Oncological Gastrectomy: Are They a Suitable Instrument for Process Standardization to Improve Process and Outcome Quality for Patients Undergoing Gastrectomy? A Retrospective Cohort Study
Open Access
- 13 February 2020
- Vol. 12 (2), 434
- https://doi.org/10.3390/cancers12020434
Abstract
(1) Background: Oncological gastrectomy requires complex multidisciplinary management. Clinical pathways (CPs) can potentially facilitate this task, but evidence related to their use in managing oncological gastrectomy is limited. This study evaluated the effect of a CP for oncological gastrectomy on process and outcome quality. (2) Methods: Consecutive patients undergoing oncological gastrectomy before (n = 64) or after (n = 62) the introduction of a CP were evaluated. Assessed parameters included catheter and drain management, postoperative mobilization, resumption of diet and length of stay. Morbidity, mortality, reoperation and readmission rates were used as indicators of outcome quality. (3) Results: Enteral nutrition was initiated significantly earlier after CP implementation (5.0 vs. 7.0 days, p < 0.0001). Readmission was more frequent before CP implementation (7.8% vs. 0.0%, p = 0.05). Incentive spirometer usage increased following CP implementation (100% vs. 90.6%, p = 0.11). Mortality, morbidity and reoperation rates remained unchanged. (4) Conclusions: After implementation of an oncological gastrectomy CP, process quality improved, while indicators of outcome quality such as mortality and reoperation rates remained unchanged. CPs are a promising tool to standardize perioperative care for oncological gastrectomy.This publication has 54 references indexed in Scilit:
- Differences in outcomes of oesophageal and gastric cancer surgery across EuropeBritish Journal of Surgery, 2012
- 7th Edition of the AJCC Cancer Staging Manual: StomachAnnals of Surgical Oncology, 2010
- What is a clinical pathway? Development of a definition to inform the debateBMC Medicine, 2010
- Klinisches Prozessmanagement – Klinische Pfade in der Chirurgie: Evidenz und PotenzialZentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, 2010
- Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2009
- Reduction of hospital stay and cost after the implementation of a clinical pathway for radical gastrectomy for gastric cancerGastric Cancer, 2008
- An epistemology of patient safety research: a framework for study design and interpretation. Part 2. Study designHeart, 2008
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- Do clinical pathways improve efficiency?Seminars in Anesthesia, Perioperative Medicine and Pain, 1999
- The Quality of CareJAMA, 1988