International Journal of Colorectal Disease

, Volume 28, Issue 7, pp 1019–1026

The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care

  • J. Hardt
  • M. Schwarzbach
  • T. Hasenberg
  • S. Post
  • P. Kienle
  • U. Ronellenfitsch
Original Article

DOI: 10.1007/s00384-013-1650-8

Cite this article as:
Hardt, J., Schwarzbach, M., Hasenberg, T. et al. Int J Colorectal Dis (2013) 28: 1019. doi:10.1007/s00384-013-1650-8

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

After implementation of a CP for rectal resections, one parameter of process quality improved and length of stay decreased.

Keywords

Colorectal surgery Clinical pathway Perioperative management Fast-track scheme Enhanced recovery Quality of care 

Supplementary material

384_2013_1650_MOESM1_ESM.docx (52 kb)
ESM 1(DOCX 51 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J. Hardt
    • 1
  • M. Schwarzbach
    • 2
  • T. Hasenberg
    • 1
  • S. Post
    • 1
  • P. Kienle
    • 1
  • U. Ronellenfitsch
    • 1
  1. 1.Department of Surgery, University Medical Center Mannheim, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Department of SurgeryKlinikum Frankfurt HöchstFrankfurt am MainGermany

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