Department of General Surgery, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain.
Br J Surg. 2010 May;97(5):714-8. doi: 10.1002/bjs.6942.
This study assessed the feasibility of a protocol-driven written clinical pathway for multidisciplinary postoperative management after oesophagectomy for oesophageal neoplasia, and examined whether the application of such a protocol could shorten hospital stay and reduce postoperative morbidity and mortality.
Consecutive patients undergoing transthoracic oesophagectomy for oesophageal neoplasia were divided into those treated between 2003 and 2008 to whom a clinical pathway was applied for postoperative management (group 1), and a control group treated between 1998 and 2002 when no clinical pathway was applied (group 2).
There were 74 patients in each group. Morbidity rates were similar in the two groups: 31 per cent in group 1 and 38 per cent in group 2. There were more pulmonary complications in group 2 (23 versus 14 per cent; P = 0.025). One patient (1 per cent) in group 1 and four (5 per cent) in group 2 died after surgery (P = 0.010). The median (range) length of hospital stay was 9 (5-98) days for group 1 and 13 (8-106) days in group 2 (P = 0.012).
Use of a written clinical pathway in patients undergoing oesophageal resection significantly reduced pulmonary complications, postoperative mortality and hospital stay.
本研究评估了多学科术后管理方案对食管肿瘤患者行食管切除术的可行性，并探讨了该方案是否能缩短住院时间，降低术后发病率和死亡率。
将连续接受经胸食管切除术治疗食管肿瘤的患者分为两组，2003 年至 2008 年接受术后管理临床路径治疗的患者为研究组 1，1998 年至 2002 年未接受临床路径治疗的患者为对照组 2。
每组各 74 例患者。两组患者的发病率相似：研究组 1 为 31%，对照组 2 为 38%。研究组 2 的肺部并发症更多（23%比 14%；P=0.025）。研究组 1 中有 1 例（1%）患者和对照组 2 中有 4 例（5%）患者术后死亡（P=0.010）。研究组 1 的住院时间中位数（范围）为 9（5-98）天，对照组 2 为 13（8-106）天（P=0.012）。
在接受食管切除术的患者中使用书面临床路径可显著降低肺部并发症、术后死亡率和住院时间。
