The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care
The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care
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DOI：
10.1007/s00384-013-1650-8
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发表时间：
2013-07-01
影响因子：
2.8
通讯作者：
Ronellenfitsch, U.
中科院分区：
文献类型：
--
作者：
Hardt, J.;Schwarzbach, M.;Ronellenfitsch, U.
有充分的证据表明临床路径（CP）的好处，但这项研究是第一个研究在已经建立了促进术后恢复的政策的情况下，CP对直肠切除术的潜在额外益处的研究。我们比较了36例接受直肠切除术和回肠造口术放置并根据CP治疗的患者。（CP组）67例患者在实施CP前接受治疗（预路径组）。过程质量的指标包括中心静脉导管和硬膜外导管的放置、与硬膜外导管移除相关的Foley导管移除日、首次动员日、恢复正常饮食日、粪便首次通过造口日和住院时间。通过发病率、死亡率、再手术率和再入院率来评估结果质量，我们发现CP组患者恢复正常饮食的时间明显更早（p = 0.001）。在首次活动日（p = 0.69）、硬膜外导管（p = 0.74）、中心静脉管路放置（p = 0.92）和Foley导管移除（p = 0.23）方面无显著差异。在前通路组中，第一次粪便通过造口较早（p = 0.04）。CP组的中位住院时间显著较短（12.5 vs. 15.0天; p = 0.008）。结果质量没有显著变化，除了CP组需要更高的翻修手术（13.9 vs. 3%，p = 0.05）。在实施CP直肠切除术后，一个过程质量参数改善，住院时间缩短。
There is ample evidence of the benefits of clinical pathways (CPs), but this study is the first to investigate the potential additional benefits of a CP for rectal resections in a setting with an already established policy of enhanced postoperative recovery.We compared 36 patients who underwent rectal resections with ileostomy placement and were treated according to a CP (CP group) with 67 patients treated before CP implementation (prepathway group). Indicators of process quality were placement of central venous line and epidural catheter, day of removal of Foley catheter in relation to removal of the epidural catheter, day of first mobilization, day of resumption of regular diet, day of first passage of stool through the stoma, and length of stay. Outcome quality was assessed by morbidity, mortality, reoperation, and readmission rates.We found that patients in the CP group resumed regular diet significantly sooner (p = 0.001). There were no significant differences regarding the day of first mobilization (p = 0.69), epidural catheter (p = 0.74), central venous line placement (p = 0.92), and removal of Foley catheter (p = 0.23). The first stool was passed through the stoma earlier (p = 0.04) in the prepathway group. Median length of hospital stay was significantly shorter in the CP group (12.5 vs. 15.0 days; p = 0.008). There were no significant changes in outcome quality, except for a significantly higher need for revisional surgery in the CP group (13.9 vs. 3 %, p = 0.05).After implementation of a CP for rectal resections, one parameter of process quality improved and length of stay decreased.