ArticleInternational journal of colorectal disease2011
Perioperative quality of care is modulated by process management with clinical pathways for fast-track surgery of the colon.
Article in International journal of colorectal disease, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Enhanced recovery strategies in colorectal surgery: is the compliance with the whole program required to achieve the target?International journal of colorectal disease · 2014Pooled it
- [Process management in surgery].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2021Review
- Article
- Clinical Pathways For Pancreatic Surgery: Are They A Suitable Instrument For Process Standardization To Improve Process And Outcome Quality Of Patients Undergoing Distal And Total Pancreatectomy? - A Retrospective Cohort Study.Therapeutics and clinical risk management · 2019Article
- Implementation and Evaluation of a Clinical Pathway for Pancreaticoduodenectomy Procedures: a Prospective Cohort Study.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2017Article
- Incomplete reporting of enhanced recovery elements and its impact on achieving quality improvement.The British journal of surgery · 2015Review
- Documented quality of care in certified colorectal cancer centers in Germany: German Cancer Society benchmarking report for 2013.International journal of colorectal disease · 2014Article
- The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care.International journal of colorectal disease · 2013Article
- Challenging boundaries: an enhanced recovery programme for radical cystectomy.Annals of the Royal College of Surgeons of England · 2013Article
- Influence of size and complexity of the hospitals in an enhanced recovery programme for colorectal resection.International journal of colorectal disease · 2012Article
- The effect of clinical pathways for bariatric surgery on perioperative quality of care.Obesity surgery · 2012Article
- Fast-track surgery in gynaecology and gynaecologic oncology: a review of a rolling clinical audit.ISRN surgery · 2012Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeClinical pathways (CPs) are increasingly used to improve quality of care. However, evidence if such improvements are also feasible in fast-track colorectal surgery is lacking. This study evaluates effects of a CP for fast-track colonic resections with respect to process and outcome quality.
methodsWe compared 78 consecutive patients undergoing colonic resections in 2008 and being treated with a CP (CP group) with 133 consecutive patients treated without CP between 2006 and 2007 (pre-CP group). Indicators for process quality were epidural catheter placement, postoperative mobilisation, resumption of solid diet, Foley catheter removal and length of stay. Outcome quality was measured through morbidity, mortality, re-operations and readmissions.
resultsIn the CP group, patients received epidural analgesia significantly more often (87.2% vs. 75.2%; p =0.04), were mobilized (38.9% vs. 20.6% on the day of surgery; p = 0.03) and resumed a solid diet earlier (60.5% vs. 49.6% on day 1; p = 0.002). Foley catheter removal and length of stay did not differ between the groups. There were no significant differences regarding morbidity (28.2% vs. 32.3%), mortality (1.2% vs. 2.3%), re-operations (6.4% vs. 9.0%) and readmissions (2.6% vs. 3.8%).
conclusionsAfter CP implementation for fast-track surgery of the colon, several indicators of process quality improved while others such as length of stay remained unaltered. There were no significant changes in outcome parameters. CPs are a viable instrument to improve specific aspects of perioperative process management, but their selective benefits have to be critically weighed against the infrastructural and personal efforts required for design and implementation.
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