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Analysis of patient-dropouts from the critical pathways for gastric cancer.

Kim S, Yoo YS, Kim JH, Min YD - Ann Surg Treat Res (2015)

Bottom Line: But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05).We concluded that total gastrectomy may not be suitable for the critical pathway.We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chosun University College of Medicine, Gwangju, Korea.

ABSTRACT

Purpose: This study was designed to determine the factors affecting completion of critical pathway for elective gastrectomy.

Methods: Since 2008, a critical pathway has been applied for elective gastrectomy at Chosun University Hospital. We retrospectively analyzed 252 patients who underwent elective gastrectomies from January 2009 to April 2013. The completion rate was determined, and risk factors for patient dropout were examined.

Results: The completion rate of the critical pathway was 45.6% (115/252). Mean length of stay was 11.7 ± 8.6 days (8-59 days). Readmission rates were 4.4% (11/252). Causes of failure for clinical pathway were systemic complications (21/137, 15.3%), intra-abdominal complications (44/137, 32.8%), patient factors (41/137, 29.9%), and wound complications (30/137, 21.9%). There were no significant differences between the two groups in age, sex, American Society of Anesthesiologists (ASA) score, operation time, readmission, and underlying disease (P > 0.05). Body mass index (P = 0.008) and pathologic stage (P = 0.001) were significantly different between the two groups. In multivariate analysis, the conventional approach (odds ratio, 2.0), and total gastrectomy (odds ratio, 5.3) were determined to be independent risk factors to drop the critical pathway. But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05).

Conclusion: We concluded that total gastrectomy may not be suitable for the critical pathway. We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.

No MeSH data available.


Related in: MedlinePlus

Critical pathway for elective gastrectomy. Preop., preoperative; Postop., postoperative; POD, postoperative day; NPO, non per os; OR, operating room; PRN, pro re nata; UGI, upper gastrointestinography; TG, total gastrectomy.
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Figure 1: Critical pathway for elective gastrectomy. Preop., preoperative; Postop., postoperative; POD, postoperative day; NPO, non per os; OR, operating room; PRN, pro re nata; UGI, upper gastrointestinography; TG, total gastrectomy.

Mentions: The CP included staging work-up, preoperative management and postoperative management. Staging work-up (e.g., abdominal computed tomography, endoscopic examination, and basic serum chemistry) was evaluated in the outpatient clinic, before surgery. After admission, patients were instructed on surgical procedures (distal gastrectomy [DG], total gastrectomy [TG]), postoperative complications, and received detailed information on the hospital course of gastrectomy (from admission to discharge) with a timetable (Fig. 1).


Analysis of patient-dropouts from the critical pathways for gastric cancer.

Kim S, Yoo YS, Kim JH, Min YD - Ann Surg Treat Res (2015)

Critical pathway for elective gastrectomy. Preop., preoperative; Postop., postoperative; POD, postoperative day; NPO, non per os; OR, operating room; PRN, pro re nata; UGI, upper gastrointestinography; TG, total gastrectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4443262&req=5

Figure 1: Critical pathway for elective gastrectomy. Preop., preoperative; Postop., postoperative; POD, postoperative day; NPO, non per os; OR, operating room; PRN, pro re nata; UGI, upper gastrointestinography; TG, total gastrectomy.
Mentions: The CP included staging work-up, preoperative management and postoperative management. Staging work-up (e.g., abdominal computed tomography, endoscopic examination, and basic serum chemistry) was evaluated in the outpatient clinic, before surgery. After admission, patients were instructed on surgical procedures (distal gastrectomy [DG], total gastrectomy [TG]), postoperative complications, and received detailed information on the hospital course of gastrectomy (from admission to discharge) with a timetable (Fig. 1).

Bottom Line: But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05).We concluded that total gastrectomy may not be suitable for the critical pathway.We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chosun University College of Medicine, Gwangju, Korea.

ABSTRACT

Purpose: This study was designed to determine the factors affecting completion of critical pathway for elective gastrectomy.

Methods: Since 2008, a critical pathway has been applied for elective gastrectomy at Chosun University Hospital. We retrospectively analyzed 252 patients who underwent elective gastrectomies from January 2009 to April 2013. The completion rate was determined, and risk factors for patient dropout were examined.

Results: The completion rate of the critical pathway was 45.6% (115/252). Mean length of stay was 11.7 ± 8.6 days (8-59 days). Readmission rates were 4.4% (11/252). Causes of failure for clinical pathway were systemic complications (21/137, 15.3%), intra-abdominal complications (44/137, 32.8%), patient factors (41/137, 29.9%), and wound complications (30/137, 21.9%). There were no significant differences between the two groups in age, sex, American Society of Anesthesiologists (ASA) score, operation time, readmission, and underlying disease (P > 0.05). Body mass index (P = 0.008) and pathologic stage (P = 0.001) were significantly different between the two groups. In multivariate analysis, the conventional approach (odds ratio, 2.0), and total gastrectomy (odds ratio, 5.3) were determined to be independent risk factors to drop the critical pathway. But there were no significant differences between total and distal gastrectomy groups in age, gender, underlying diseases, ASA score, readmission, operation time, and cause of dropout (P > 0.05).

Conclusion: We concluded that total gastrectomy may not be suitable for the critical pathway. We suggest that the critical pathway for elective distal gastrectomy is divided 2 subgroups, according to the surgical approach.

No MeSH data available.


Related in: MedlinePlus