Department of General, Visceral, Vascular, and Thoracic Surgery, Klinikum Frankfurt Höchst, Gotenstrasse 6-8, 68150, Frankfurt a. M., Germany.
Int J Colorectal Dis. 2011 Dec;26(12):1567-75. doi: 10.1007/s00384-011-1260-2. Epub 2011 Jun 25.
Clinical pathways (CPs) are increasingly used to improve quality of care. However, evidence if such improvements are also feasible in fast-track colorectal surgery is lacking. This study evaluates effects of a CP for fast-track colonic resections with respect to process and outcome quality.
We compared 78 consecutive patients undergoing colonic resections in 2008 and being treated with a CP (CP group) with 133 consecutive patients treated without CP between 2006 and 2007 (pre-CP group). Indicators for process quality were epidural catheter placement, postoperative mobilisation, resumption of solid diet, Foley catheter removal and length of stay. Outcome quality was measured through morbidity, mortality, re-operations and readmissions.
In the CP group, patients received epidural analgesia significantly more often (87.2% vs. 75.2%; p =0.04), were mobilized (38.9% vs. 20.6% on the day of surgery; p = 0.03) and resumed a solid diet earlier (60.5% vs. 49.6% on day 1; p = 0.002). Foley catheter removal and length of stay did not differ between the groups. There were no significant differences regarding morbidity (28.2% vs. 32.3%), mortality (1.2% vs. 2.3%), re-operations (6.4% vs. 9.0%) and readmissions (2.6% vs. 3.8%).
After CP implementation for fast-track surgery of the colon, several indicators of process quality improved while others such as length of stay remained unaltered. There were no significant changes in outcome parameters. CPs are a viable instrument to improve specific aspects of perioperative process management, but their selective benefits have to be critically weighed against the infrastructural and personal efforts required for design and implementation.
临床路径（CPs）越来越多地被用于提高医疗质量。然而，在快速通道结直肠手术中，这种改进是否可行的证据还很缺乏。本研究评估了快速通道结肠切除术 CP 的实施对流程和结果质量的影响。
我们比较了 2008 年接受 CP 治疗的 78 例连续结肠切除术患者（CP 组）与 2006 年至 2007 年期间未接受 CP 治疗的 133 例连续患者（CP 组）。过程质量的指标包括硬膜外导管放置、术后活动、恢复固体饮食、导尿管拔除和住院时间。通过发病率、死亡率、再次手术和再入院来衡量结果质量。
CP 组患者接受硬膜外镇痛的比例明显更高（87.2%比 75.2%；p=0.04），手术当天活动的比例更高（38.9%比 20.6%；p=0.03），恢复固体饮食的时间更早（60.5%比 49.6%在第 1 天；p=0.002）。两组之间的导尿管拔除和住院时间没有差异。发病率（28.2%比 32.3%）、死亡率（1.2%比 2.3%）、再次手术（6.4%比 9.0%）和再入院（2.6%比 3.8%）无显著差异。
CP 应用于结肠快速通道手术后，一些流程质量指标得到了改善，而其他指标如住院时间则没有改变。结果参数没有显著变化。CP 是一种可行的工具，可以改善围手术期流程管理的特定方面，但在设计和实施时，必须对其所需的基础设施和个人努力的选择性益处进行严格权衡。
