The efficacy of clinical pathway in gastric cancer surgery

Abstract

Objective: Clinical pathways are useful tools for surgical quality improvement and better peri-operative clinical outcomes for patients undergoing major surgery. This study aimed to evaluate the influence of clinical pathway on early postoperative outcomes for gastric cancer patients. Material and Methods: The study was designed as a retrospective cohort observational study. Patients who had undergone curative gastrectomy for gastric cancer were evaluated by using the gastric cancer database, which was prospectively maintained. The patients were divided into two groups based on the date when the clinical pathway was first used: The control group (May 2015-May 2016) and the clinical pathway group (June 2016-December 2017). Early postoperative outcomes including the length of hospital stay, start of the day of diet, and 30-day complications including reoperation, and operative mortality were compared after propensity score matching. Results: A total of 101 patients were analyzed, and the data of 70 patients (35 patients in each group) were compared after matching. Clinical pathway group demonstrated shorter hospital stay, earlier nasogastric tube removal, and start of earlier liquid/soft diet. Overall complication rate was lower in the clinical pathway group, while there was no statistically significant difference in major complication rates. No statistically significant difference was observed between the groups in terms of reoperation and operative mortality. Conclusion: Clinical pathway may shorten the postoperative length of hospital stay and reduce the overall complication rate without increasing major morbidity in patients undergoing elective gastric cancer surgery.

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“…Sixteen studies met the inclusion criteria for studies of pathway interventions (Table 5). Most studies were conducted in the United States, 30,31,34,49-52,54,55 and others were conducted in Turkey, 53,58 South Korea, 56 Germany, 57 Belgium, 28 and China. 27,59 Disease sites included breast, 28,49-52,57,58 colorectal, 55 lung, 27,30,31 gastric, 53,56 a combination of disease sites, 54 or patients with bone metastases.…”

“…49 All studies were observational studies conducted without random assignment of patients to treatment or control groups. All studies were either a comparison of groups before versus after implementation of a pathway 27,28,30,34,49,50,53,54,57,58 or contemporaneous studies of patients who were on pathway versus off pathway. 31,51,52,55,56 Balance of study characteristics between intervention and control groups is reported in Table 5; some studies used statistical techniques such as propensity score matching to ensure that groups were balanced on characteristics such as age, stage, and extent of comorbidities.…”

“…Four studies assessed the impact of pathways on mean LOS:There was a significantly reduced LOS for patients undergoing gastrectomy for gastric malignancy (11 days prepathway v 9 days postpathway [95% CI for mean difference, 1 day to 5 days]). 53 One study of surgery for breast cancer reported a mean LOS of 4.5 days prepathway versus 3.4 days postpathway (95% CI for mean difference, 0.78 days to 1.5 days). 57 A study of operable patients with breast cancer reported a mean LOS of 7 days prepathway and 4.1 days postpathway (CI not reported).…”

“…There was a significantly reduced LOS for patients undergoing gastrectomy for gastric malignancy (11 days prepathway v 9 days postpathway [95% CI for mean difference, 1 day to 5 days]). 53…”

“…Most studies were conducted in the United States, 30,31,34,[49][50][51][52]54,55 and others were conducted in Turkey, 53,58 South Korea, 56 Germany, 57 Belgium, 28 and China. 27,59 Disease sites included breast, 28,49-52,57,58 colorectal, 55 lung, 27,30,31 gastric, 53,56 a combination of disease sites, 54 or patients with bone metastases. 34 The results were reported for a wide variety of settings including networks of practices, 31 an National Cancer Institute comprehensive cancer center with a hub and spoke model, 49 single institutions-either academic settings in the United States or internationally, 27,28,30,34,50,[56][57][58] or community-based practices.…”