Clinical Pathways for Oncological Gastrectomy: Are They a Suitable Instrument for Process Standardization to Improve Process and Outcome Quality for Patients Undergoing Gastrectomy? A Retrospective Cohort Study

Abstract

(1) Background: Oncological gastrectomy requires complex multidisciplinary management. Clinical pathways (CPs) can potentially facilitate this task, but evidence related to their use in managing oncological gastrectomy is limited. This study evaluated the effect of a CP for oncological gastrectomy on process and outcome quality. (2) Methods: Consecutive patients undergoing oncological gastrectomy before (n = 64) or after (n = 62) the introduction of a CP were evaluated. Assessed parameters included catheter and drain management, postoperative mobilization, resumption of diet and length of stay. Morbidity, mortality, reoperation and readmission rates were used as indicators of outcome quality. (3) Results: Enteral nutrition was initiated significantly earlier after CP implementation (5.0 vs. 7.0 days, p < 0.0001). Readmission was more frequent before CP implementation (7.8% vs. 0.0%, p = 0.05). Incentive spirometer usage increased following CP implementation (100% vs. 90.6%, p = 0.11). Mortality, morbidity and reoperation rates remained unchanged. (4) Conclusions: After implementation of an oncological gastrectomy CP, process quality improved, while indicators of outcome quality such as mortality and reoperation rates remained unchanged. CPs are a promising tool to standardize perioperative care for oncological gastrectomy.

Improving management of hospitalised patients with COVID-19: algorithms and tools for implementation and measurement

“…Given the fact that most of the interventions in this set of algorithms are supported by clear parameters/findings, which indicate when to initiate, we expect that the interventions will be activated earlier. 26 In addition, the benefit of using this toolkit is not limited to increased efficiency in resource utilisation or appropriate referrals. Our hospital has recruited and reallocated many non-intensive care clinicians to manage patients with COVID-19.…”

“…Given the fact that most of the interventions in this set of algorithms are supported by clear parameters/findings, which indicate when to initiate, we expect that the interventions will be activated earlier. 26 …”

Patientenorientierte Versorgungssteuerung im Krankenhaus

“…Hierdurch sollen die verweildauerabhängigen Kosten gesenkt und die Behandlung möglichst vieler Patienten bei gleichbleibenden Ressourcen gewährleistet werden. Diese rein ökonomische Betrachtungsweise kollidiert nicht selten mit dem Berufsethos von Ärzten und anderen in der unmittelbaren Patientenversorgung tätigen Mitarbeitern (Donabedian 1990;Lenk et al 2005 (Hardt et al 2013;Muehling et al 2008;Richter-Ehrenstein et al 2012;Ronellenfitsch et al 2012;Schwarzbach et al 2010aSchwarzbach et al , 2010bSchwarzbach et al , 2010cSchwarzbach et al , 2011Téoule et al 2019Téoule et al , 2020aTéoule et al , 2020b.…”

Radioembolization versus portal vein embolization for contralateral liver lobe hypertrophy: effect of cirrhosis

“…Another study by Edeline et al stated that TARE induces similar increases in FLR volume compared to PVE in patients with cirrhosis [ 16 ]. A recent review by Birgin et al analyzed a total of 16 studies, comprising 602 patients, and stated that the influence of cirrhosis on hypertrophy of the contralateral liver lobe after TARE remains controversial, with no significant difference of kinetic growth rate in the three included studies which assessed only patients with cirrhosis, compared to patients without cirrhosis [ 17 ].…”