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ArticleTitle Clinical Significance of a Standardized Clinical Pathway in Gastrectomy Patients
AuthorList Teruo Kiyama1, Takashi Tajiri1, Toshiro Yoshiyuki1, Kyoko Mitsuhashi2, Yuya Ise3, Takashi Mizutani1, Takeshi Okuda1, Itsuro Fujita1, Gotaro Masuda1, Shunji Kato1, Norio Matsukura1, Akira Tokunaga1 and Sachiko Hasegawa2
Affiliation 1Department of Surgery (I), Nippon Medical School
2Department of Nursing, Nippon Medical School Hospital
3Division of Pharmaceutical Service, Nippon Medical School Hospital
Language JA
Volume 70
Issue 3
Year 2003
Page 263-269
Received October 4, 2002
Accepted Nobember 21, 2002
Keywords clinical pathway, gastrectomy, outcomes, length of hospital stay, medical costs
Abstract In traditional practice patterns, physicians take care of all clinical decisions, such as diagnosis, treatment, and recovery. In the Nippon Medical School Hospital a clinical pathway for distal gastrectomy patients, recorded as a post-operative care map, was introduced in August 2000. In January 2001 the post-operative management was analyzed and standardization of practice was carried out with printed order sets, such as drugs and infusion solutions. The aim of this study was to evaluate the clinical significance of the clinical pathway for gastrectomy patients by employing standardized postoperative management and printed order sets.
Patients and methods: From January 2001 to December 2001, 87 patients underwent distal (43), total (28), proximal (7) and partial gastrectomy (9) for gastric cancer (stage IA: 47, IB: 9, II: 7, IIIA: 8, IIIB 2, IV: 10) and gastrointestinal stromal tumor (4). These patients were randomly assigned to either the main building or the east building of our hospital. In the main building 38 patients were looked after using traditional practice (control group). In the east building 47 patients were looked after according to the clinical pathway (path group) and 2 patients were excluded from the path group because of neo-adjuvant chemotherapy and severe heart failure. Aspects of the patients' outcomes, including length of stay, the first day of the diet, morbidity, and medical costs, were compared between the path group and the control group. All data were expressed as means±standard deviation. Statistical analyses were made using Student t-test, Mann-Whitney U-test, and χ2 test, and the 5%level was chosen for statistical significance.
Results: The length of the hospital stay was 27.1±10.0 and 40.8±26.1 days (p<0.005) and the length of post-operative stay was 18.1±9.5 and 28.2±22.3 days (p<0.01) in the path group and the control group, respectively. The post-operative day when the diet was started for the path and control groups was 6.8±8.9 and 8.2±7.2, respectively; however, the length of the intravenous infusion for the two groups was 11.8±1.1 and 16.5±1.2 days (p<0.01), respectively. There was no statistically significant difference in the morbidity rate between the path group (3/47) and the control group (5/38). The total cost was \1,502,587±41,650 in the path group and \1,932,197±131,030 in the control (p<0.001).
Conclusion: A clinical pathway for gastrectomy patients proved useful to optimize their postoperative care, including medication management and diet education. It is suggested that the implementation of a standardized clinical pathway for gastrectomy patients reduced the length of the hospital stay and the medical costs.
Correspondence to Teruo Kiyama, Department of Surgery (I), Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kiyama@nms.ac.jp

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