J Korean Surg Soc.  2011 Aug;81(2):96-103. 10.4174/jkss.2011.81.2.96.

Is the critical pathway effective for the treatment of gastric cancer?

• Jeong SH
• Yoo MW
• Yoon HM
• Lee HJ
• Ahn HS
• Cho JJ
• Kim HH
• Lee KU
• Yang HK

• KMID: 2096662
• DOI: http://doi.org/10.4174/jkss.2011.81.2.96

Abstract

PURPOSE
The present study was conducted to investigate the low compliance rate of the critical pathway (CP) and whether CP is effective for treatment of gastric cancer in radical gastrectomy.
METHODS
The medical records of 631 patients who had undergone radical gastrectomy with D2 lymph node dissection were reviewed. This study compared data from patients in early gastric cancer (EGC) and advanced gastric cancer (AGC) groups, which were further subdivided into general care (non-CP) and CP groups.
RESULTS
The mean length of preoperative hospital stays were significantly different between the EGC and AGC patients (P < 0.05). However, there was no difference in the mean length of postoperative hospital stays between non-CP and CP groups among either EGC patients or AGC patients (P > 0.05). The postoperative and total cost of hospitalization was not statistically different between either of the groups (P > 0.05); however, the mean preoperative costs were significantly different (P < 0.05).
CONCLUSION
We conclude that use of the CP following gastrectomy is unnecessary. To decrease the length of hospital stay and associated costs, preoperative examination and consultation should be performed before admission.

Keyword

Critical pathways; Fast-track; Stomach neoplasms; Gastrectomy

MeSH Terms

Compliance
Critical Pathways
Gastrectomy
Hospitalization
Humans
Length of Stay
Lymph Node Excision
Medical Records
Stomach Neoplasms

Figure

• 

  Fig. 1 Critical pathway for hospital staff. HD, hospital day; Pre-op, preoperative; OP, operation; e', electrolyte; X matching for Tf, cross matching for transfusion; CBC, complete blood cell count; CPA, Chest PA; v/s, vital sign; Bwt, body weight ; Ht, height; I/O, input and output; L-tube, levin tube; PCA, patient controlled analgesia; W/A, ward ambulation; BR, bed rest; SFP, semi-Fowlers position; A/C, active cough; D/B, deep breathing.

• 

  Fig. 2 Critical pathway for patient.

• 

  Fig. 3 Comparison of application rate, completion rates in four disease groups. La. Cholecystectomy, laparoscopic cholecystectomy.

Reference

1. Pearson SD, Goulart-Fisher D, Lee TH. Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med. 1995. 123:941–948.

2. Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An introduction to critical paths. Qual Manag Health Care. 1992. 1:45–54.

3. Hindle D, Yazbeck AM. Clinical pathways in 17 European Union countries: a purposive survey. Aust Health Rev. 2005. 29:94–104.

4. Sermeus W, Depreitere R, De Waele K, Vanhaecht K, Vlayen J. An intruduction to clinical pathways. 2005. Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE).

5. Zander KS, Bower KA, Etheredge MR. Nursing case management: blueprints for transformation. 1987. Boston: New England Medical Center Hospital.

6. Pritts TA, Nussbaum MS, Flesch LV, Fegelman EJ, Parikh AA, Fischer JE. Implementation of a clinical pathway decreases length of stay and cost for bowel resection. Ann Surg. 1999. 230:728–733.

7. Stephen AE, Berger DL. Shortened length of stay and hospital cost reduction with implementation of an accelerated clinical care pathway after elective colon resection. Surgery. 2003. 133:277–282.

8. Lin DX, Li X, Ye QW, Lin F, Li LL, Zhang QY. Implementation of a Fast-Track clinical pathway decreases postoperative length of stay and hospital charges for liver resection. Cell Biochem Biophys. 2011. 05. 10. [Epub]. DOI: 10.1007/s12013-011-9203-7.

9. Huber TS, Carlton LM, Harward TR, Russin MM, Phillips PT, Nalli BJ, et al. Impact of a clinical pathway for elective infrarenal aortic reconstructions. Ann Surg. 1998. 227:691–699.

10. Niino T, Hata M, Sezai A, Yoshitake I, Unosawa S, Shimura K, et al. Optimal clinical pathway for the patient with type B acute aortic dissection. Circ J. 2009. 73:264–268.

11. Santillan A, Govan L, Zahurak ML, Diaz-Montes TP, Giuntoli RL 2nd, Bristow RE. Feasibility and economic impact of a clinical pathway for pap test utilization in Gynecologic Oncology practice. Gynecol Oncol. 2008. 109:388–393.

12. Koch MO, Smith JA Jr. Influence of patient age and co-morbidity on outcome of a collaborative care pathway after radical prostatectomy and cystoprostatectomy. J Urol. 1996. 155:1681–1684.

13. Leibman BD, Dillioglugil O, Abbas F, Tanli S, Kattan MW, Scardino PT. Impact of a clinical pathway for radical retropubic prostatectomy. Urology. 1998. 52:94–99.

14. Zand DJ, Brown KM, Lichter-Konecki U, Campbell JK, Salehi V, Chamberlain JM. Effectiveness of a clinical pathway for the emergency treatment of patients with inborn errors of metabolism. Pediatrics. 2008. 122:1191–1195.

15. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg. 2005. 92:1099–1102.

16. Yang HK, Lee HJ, Ahn HS, Yoo MW, Lee IK, Lee KU. Safety of modified double-stapling end-to-end gastroduodenostomy in distal subtotal gastrectomy. J Surg Oncol. 2007. 96:624–629.

17. Hirasaki S, Tanimizu M, Moriwaki T, Hyodo I, Shinji T, Koide N, et al. Efficacy of clinical pathway for the management of mucosal gastric carcinoma treated with endoscopic submucosal dissection using an insulated-tip diathermic knife. Intern Med. 2004. 43:1120–1125.

18. Dy SM, Garg PP, Nyberg D, Dawson PB, Pronovost PJ, Morlock L, et al. Are critical pathways effective for reducing postoperative length of stay? Med Care. 2003. 41:637–648.

19. Wright CD, Wain JC, Grillo HC, Moncure AC, Macaluso SM, Mathisen DJ. Pulmonary lobectomy patient care pathway: a model to control cost and maintain quality. Ann Thorac Surg. 1997. 64:299–302.

20. Holmboe ES, Meehan TP, Radford MJ, Wang Y, Marciniak TA, Krumholz HM. Use of critical pathways to improve the care of patients with acute myocardial infarction. Am J Med. 1999. 107:324–331.

21. Pearson SD, Kleefield SF, Soukop JR, Cook EF, Lee TH. Critical pathways intervention to reduce length of hospital stay. Am J Med. 2001. 110:175–180.