The efficacy of clinical pathway in gastric cancer surgery
Ali Güner1,2
1Department of General Surgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey
2Department of Biostatistics and Medical Informatics, Karadeniz Technical University Institute of Medical Science, Trabzon, Turkey
Abstract
Objective: Clinical pathways are useful tools for surgical quality improvement and better peri-operative clinical outcomes for patients undergoing major surgery. This study aimed to evaluate the influence of clinical pathway on early postoperative outcomes for gastric cancer patients.
Material and Methods: The study was designed as a retrospective cohort observational study. Patients who had undergone curative gastrectomy for gastric cancer were evaluated by using the gastric cancer database, which was prospectively maintained. The patients were divided into two groups based on the date when the clinical pathway was first used: The control group (May 2015-May 2016) and the clinical pathway group (June 2016-December 2017). Early postoperative outcomes including the length of hospital stay, start of the day of diet, and 30-day complications including reoperation, and operative mortality were compared after propensity score matching.
Results: A total of 101 patients were analyzed, and the data of 70 patients (35 patients in each group) were compared after matching. Clinical pathway group demonstrated shorter hospital stay, earlier nasogastric tube removal, and start of earlier liquid/soft diet. Overall complication rate was lower in the clinical pathway group, while there was no statistically significant difference in major complication rates. No statistically significant difference was observed between the groups in terms of reoperation and operative mortality.
Conclusion: Clinical pathway may shorten the postoperative length of hospital stay and reduce the overall complication rate without increasing major morbidity in patients undergoing elective gastric cancer surgery.
Keywords: Gastrectomy, gastric cancer, clinical pathway, perioperative care, recovery of function, quality improvement
Cite this article as: Güner A. The efficacy of clinical pathway in gastric cancer surgery. Turk J Surg 2020; 36 (1): 39-47.
Ethics permission for the study was obtained from the ethics committee (2019/177).
Written consent of all the patients was received.
Externally peer-reviewed.
Concept - A.G.; Design - A.G.; Supervision - A.G.; Resource - A.G.; Data Collection and/or Processing - A.G.; Analysis and/or Interpretation - A.G.; Writing Manuscript - A.G.; Critical Reviews - A.G.
There is no conflict of interest in this study.
This study has no financial support.